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Full text of "Observations on the disease called the plague, on the dysentery, the ophthalmy of Egypt, and on the means of prevention : with some remarks on the yellow fever of Cadiz, and the description and plan of an hospital for the reception of patients affected with epidemic and contagious diseases"

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Founded 1836 

U. S. Department of Health, Education, and Welfare 

Public Health Service 



OBSERVATIONS / / 2 2- . 












One of the Chief Surgeons of the Consular Guards, &c. &c. 



Of the University of EdinDurgh, Member of the Royal College 

of Surgeons of that City, and late S'.ugeon of the 

Shropshire Regiment of Militia. 





Punted and sold bv T. V J. SWORDS, Printers to the FacTlt/ 
of Physic of Columbia College. 



V . W -\ 


llcS % Z-7 


AMIDST the variety of acute diseases 
which have at different times depopu- 
lated the earth, and imperiously called 
forth the energies of governments, and 
the solicitude and exertions of indivi- 
duals, the plague has long maintained a 
fatal pre-eminence. After ravaging, for 
several centuries, the finest countries of 
Europe, Asia, and Africa, it seems at 
length to have usurped a lasting domi- 
nion over the imperial city of Constan- 
tinople, the coast of the Levant, and 
the whole country of the Ptolomies, 
where, conjoined with the sloth, filth, 
and misery of the inhabitants, it bids 
defiance to the power of medicine. 

( iv ) 

Happily for this country, we have 
long been strangers to its attacks. A 
period, indeed, of more than a century 
has elapsed since it has been observed 
in this metropolis. But although thus 
fortunately estranged from its destructive 
influence, we must still continue to feel 
a lively interest in the progress of this 
disease, and more particularly since the 
occurrence of the late campaign in 
Egypt. That country may again be- 
come the theatre of war, and it is there- 
fore doubly incumbent on us to procure 
every possible information on the sub- 
ject of its diseases, in order that we may 
the better be enabled to preserve the 
valuable lives of our brave troops. 

It is to be sincerely regretted, that 
none of our own countrymen who be- 
longed to the army of Egypt have, as 
yet, come forward with the information 
which they must have collected on this 
disease; and we are therefore constrained. 

( y ) 

for the present, to have recourse to the 
writings of the medical officers of the 
French army, who, it may here be re- 
marked, possessed more extensive means 
of acquiring an accurate knowledge of 
the subject than our medical stalf, ow- 
ing to their longer residence in Egypt, 
and to their having had a larger field 
for practice and observation, from the 
superior magnitude of the French army. 
But independently of the utility of 
the knowledge of the plague and epi- 
demics of Egypt, in a military and po- 
litical point of view, the subject pos- 
sesses the most general and extensive 
claims to our attention. A just idea of 
the nature of diseases is only to be ac- 
quired by a knowledge and investigation 
of various facts; and that physician 
who, to a sound judgment, unites the 
most extensive acquaintance with the 
maladies of different countries, will cer- 

{ vi ) 

tainly be, ceteris paribus, the best prac- 

Such then being my views in under- 
taking the translation of this work, I 
trust that it will fulfil the object pro- 
posed ; and I sincerely hope, • that a 
knowledge of the facts therein con- 
tained may conduce to throw further 
light on the contagious and epidemic dis- 
eases both of this and other countries. 



v/NE of the objects of the work of 
Assalini is to combat a prejudice among 
the European nations, that the disease 
which they call the Plague is contagious. 
He derives his facts and arguments 
from the Mahometan regions which he 
lias visited; and they come with great 
force from an eye-witness of so much 
intelligence and candour. But there is 
another source whence the like consi- 
derations may be deduced. We mean 
the narratives of the people themselves, 
into whose cities the contagion of plague 
has been pretended to have been im- 
ported from the Turkish countries. The 

( viii ) 

greater part of these relations will be 
found defective in their proofs; and no- 
thing more is necessary to evince their 
inconclusiveness than to peruse those 
publications with this object in view. If 
it turns out, upon investigation, that this 
disorder is really not contagious, and that 
a great noise has been made about it 
without sufficient cause, and for no good 
purpose, then a great error in society 
will be corrected, and many of the evils 
consequent upon it will be removed. 
This inquiry is the more important, be- 
cause the importers of plague from the 
Levant argue in about the same man* 
ner with the importers of yellow fever 
from the West-Indies. 

The misrepresentations and mistakes 
which have prevailed in America on 
the subject of yellow fever, have been 
pretty fully detected and exposed. It 
has, however, been a work of time and 
labour; but in a country, and among 

a people where the utmost freedom of 
inquiry is allowed, and where the whole 
•body of citizens have a deep interest, as 
well as curiosity, to examine thoroughly 
the alleged contagiousness of their au- 
tumnal fevers, there has been collected 
a great mass of evidence against that 
opinion within the last ten years. And 
the result of this minute and patient dis- 
cussion, that there is no morbid venom 
or poison sui generis produced by any 
secretory action of the vessels during a 
yellow fever, whereby that disease .can 
be communicated from one person to 
another, has led many gentlemen to 
doubt the contagiousness of the distem- 
per, which, in a small region of Europe, 
bordering on the Mediterranean sea, be- 
tween the Adriatic and Atlantic, has 
been denominated the Plague. The con- 
nection between the United States and 
the North African powers has strength- 
ened these doubts, by affording us strong 

$ x ) 

evidence against the opinions prevailing 
among the Christian nations, through 
Dr. Cowdrey, an American prisoner at* 
Tripoli, and Dr. Davis, Consul at Tunis, 
in Barbary. And the expeditions to 
Egypt have had this good effect, that 
they have enabled several cautious ob- 
servers to see for themselves that ma- 
lady, the very name of which, like that 
of an apparition among weak and cre- 
dulous people, fills the inhabitants of 
Christian Europe with terror; and have 
induced them to bear witness against its 
contagious nature. 

Contemplating the alarming stories 
about the importation of the plague into 
Christendom, and the expensive esta- 
blishments that have been made for the 
purpose of keeping it out ; it appears ex- 
tremely probable all this dread of con- 
tagion, and the rigour of quarantines 
and lazarettoes to guard against it, have, 
in reality, no better foundation than the 

( ** ) 

equally positive, though delusive tales 
propagated about our domestic yellow 
tfever. With this view, Bertrand's Rela- 
tion Historiquc de la Peste de Marseille, 
en 1720, is worthy of being read. As 
this is the great authority whence the 
contagionists derive their arguments, a 
copy was sought, and fortunately pro- 
cured from the very place whose cala- 
mities are therein related. This book is 
the more worthy of perusal, because, by 
establishing the belief of contagion in 
plague, it gave rise to the famous code 
of regulations which were published in 
17 80, under the title of Reglemens du 
Bureau de Sante. And these rules and 
orders of Marseilles, predicated upon 
the existence of a most subtil and viru- 
lent pestilential contagion, have had a 
credit given to them almost as exten- 
sive and obligatory as the maritime laws 
of Rhodes and Oleron. 

The narrative of Bertrand is the ground- 

( xii ) 

work of a mighty superstructure. His 
historical relation serves the same purpose 
to prove the contagiousness of the plague, 
and its introduction from Syria into 
France, as Chisholm's Essay answers to 
show that the Malignant Pestilential 
Fever was carried from Guinea to the 
West-Indies and the United States. The 
improbable and unfounded nature of 
the latter account is now generally nn- 
' derstood, and candid members of the 
profession excuse, while they lament 
such a capital mistake in so sensible and 
respectable a writer. This discovery na- 
turally prompted an inquiry into the 
weight and pertinency of the evidence 
which Bertrand's volume contains. For, 
if it should be found to be weak or irre- 
levant, then the vision about contagion 
vanishes, and all the apparatus to keep it 
away becomes vain or useless. 

" The facts, (says Dr. Mitchill, in 
his letter to the Board of Health in New- 

( xiii ) 

York, September 10, 1806), on the oc- 
currence of the memorable mortality at 
Marseilles in 17^0, as I collect them 
from Bertrand's book, warrant no such 
conclusion as he has drawn from them, 
and may be summarily stated thus: 
That city had suffered, at different times, 
nineteen visitations of plague that were 
important enough to be remembered; 
this was the twentieth. This year, corn 
and other necessaries were dearer than 
common, not so much, says the author, 
from actual scarcity, as from the remark- 
able want of money; but which, to all 
poor people, amounted to the same thing. 
" The season is described as not being 
remarkably different from common years. 
In the course of June, the inhabitants be- 
came sickly. The disease began among 
sailors and indigent people near the har- 
bour, and gradually extended the circle 
of its action. The people and their ma- 
gistrates grew uneasy, and expressed 

{ xiv ) 

(different opinions about it, and, on re- 
ferring it to the members of the medical 
profession, they, as usual, also differed 
in opinion. One class of them expressed 
their solemn conviction, that it neither 
proceeded from a vitiated atmosphere 
nor a scantiness of food, but was derived 
from contagion imported from Sidon, in 
Syria, on board a ship which sailed thence 
January 31, and arrived on the 25 th of 
May, with a clean bill of health, and a 
sickly crew, at Marseilles. Mr. Bertrand, 
who is the chief of this sect, says, the 
vessel also touched at Tripoli and Cyprus, 
and brought certificates of health from 
both those places. The Captain, during 
the voyage, had put into Leghorn, on 
account of the wretched and dying con- 
dition of his crew, and had received a 
certificate from a physician and surgeon 
there, purporting that they died of a ma- 
lignant pestilential fever. Several other 
vessels arrived from the same ports about 

( xv J 

the last of May and in the beginning 
of June, bringing foul bills, there being 
suspicions and appearances of plague; 
but none of their crews are stated to 
have been unhealthy. On the other 
hand, there was a numerous and intelli- 
gent body that contended in favour of its 
local origin at home. These ascribed 
the endemic to atmospheric distempera- 
ture, vile and scanty food, and to fear and 
the depressing passions. This side of the 
question was maintained strenuously in 
numerous publications, by Mr. Deidier, 
Professor Maille of Capors, Dr. Boyer 
of Toulon, and Professors Chicoyneau 
and Verny of Montpellier. All those 
were men of high character, and, ex- 
cept one, were eye witnesses of the dis- 
temper; beheld it in its worst forms, 
and deliberately spoke and printed their 
conviction, that it was an ordinary ma- 
lignant disease, and by no means conta- 

{ xvi ) 

' i( The points of importation and domes- 
tic origin were as fiercely disputed at that 
time, as they have ever been since. Mr. 
Bcrtrand, Mr. Pons, Mr. Peysonnel, bro- 
ther Victorin, and the other persons who 
were contagionists, ascribed all the mis- 
chief to the arrival of the vessels from 
the Levant, and satisfied themselves of 
the landing of the contagion at the la- 
zaretto; whence, after having multiplied 
and recruited itself, it slipped insensi- 
bly into the neighbouring part of the 
town, crept insidiously from house to 
house, and from street to street, until 
it gained possession of the whole; and, 
finally, glided by the same secret and 
silent advances into the adjoining coun- 
try. Their opponents considered all this 
to be prejudice, mistake, and delusion. 
There was no proof, they said, that con- 
tagion existed in the Syrian and Cyprian 
ports when the accused ship left them. 
If contagion had existed, there was no 

( xvii ) 

evidence of its having been taken on 
board. In a voyage of nearly three 
months' duration, nothing was more 
common than the existence of sickness 
among a crew. There was no necessity 
of charging such a sickness to the ports 
whence they sailed; for it was much 
more probable that it arose on ship- 
board, and was of strictly local origin 
there. The occurrence of fevers, and 
of death during the passage, had no- 
thing to do with the places whence they 
took their last departure. Persons at 
sea had no more security against sickness 
and mortality than when on shore, and 
therefore might, in the nature of things, 
become infirm, and even end their days, 
from causes arising within the vessel it- 
self. So, if a ship had arrived in a sickly 
and unclean condition at any city, it did 
not follow that her unhealthiness and 
filth must be spread far and wide among 
the inhabitants. Independent of all these 
a 2 

( xviii ) 

considerations, on examining the facts 
it was found, that this dangerous dis- 
ease had been progressing, by regular 
steps, among the lower class of people; 
that it resembled the home-bred malig- 
nant distemper of 1709 and 1710; that 
it was connected with the wretchedness 
and famished condition of the poorer in- 
habitants, who compose the great body 
of society; and, in short, that the popu- 
lace, starving upon meagre and damaged 
food, became sickly of course from the 
common necessity of the case. The most 
decisive proof was adduced, that before 
the arrival of the suspected ship, to wit, 
early in May, and in April, and even 
during part of the preceding year, 1719, 
diseases, accompanied with buboes, pa- 
rotids, and carbuncles, had appeared. 
The sudden deaths of the porters were 
not owing to a blast of pestilential con- 
tagion, inhaled from the bales of goods 
they were landing, but to debility and 

( xix ) 

impoverishment consequent upon bad 
living, and to the sudden and total failure 
of their strength when applied to carry 
a load. The attacks were in situations 
so remote from each other, and the pa- 
tients so utterly free from all communi- 
cation, cither with one another or with 
the ship and her contents, that the dis- 
temper was truly endemic in its origin, 
uncontagious in its nature, and as much 
a domestic malady as any other that 
ever afflicted the inhabitants. 

" If Mr. Malthus, said Dr. Mitchill, 
had thought of this case, he could not 
have given a better example than it af- 
fords, of the increase of human beings 
beyond the amount of subsistence ; and 
of the occurrence of a pestilence, to rid 
society of its superfluous members, and 
reduce the number of mouths tothequan- 
tity of aliment provided to feed them. 

" While this severe, though necessary 
work was going on, of trimming off the 

( xx ) 

luxuriance and overgrowth of their po- 
pulation, the Marseillians bore it with 
the patience with which mankind gene- 
rally endure misfortunes. Matters went 
on from bad to worse, until near the end 
of July, when an opinion was propa- 
gated that the disorder among them was 
the true Asiatic plague. This was at first 
violently opposed by the multitude. The 
authors of it were reviled and insulted. 
A more wilful and pernicious falsehood, 
they declared, had never been propa- 
gated to the injury of the Burghers. But 
although these were incredulous, there 
were, at length, persons enough to give 
full credit to the story. The rumour that 
the plague had been brought from .the 
Turkish dominions, was propagated far 
and wide. It gained believers almost in 
every place to which it extended ; and in 
a very short time this unhappy city was 
put under an interdict, and cut off from 
the intercourse of society, lest the plague. 

( xxi ) 

by which it was desolated, should over- 
whelm the adjacent settlements, villages 
and towns by its contagion. 

" As soon as the disease was declared 
to be the plague, a series of new proceed- 
ings and sorrows began, infinitely more 
tragical than all that had happened be- 
fore. The surrounding places refused 
to bring supplies to market. The par- 
liament indeed forbade the intercourse 
under severe penalties. Barricades were 
ordered for the purpose of keeping them 
in. They were prohibited going into 
the country for safety, or even to buy 
provisions. The immediate consequence 
was an extreme and general failure of 
food. The bakers were destitute of corn 
and meal. As early as the third of 
August the bread fell short, and the 
multitude marched from one street to 
another, insulting the bakers at their 
houses. They were agitated by rage 
and tumult. At length, to prevent inv 

( xxii ) 

mediate famine, two markets were esta- 
blished on the great avenues, six miles 
from the city, and another on the sea- 
side. These were fortified by double 
barriers, officers and guards, to allow 
sales, but to prevent communications. 
Thus were these ill-fated people sur- 
rounded, and, in great numbers, literally 
starved to death. 

" For, though these supplies relieved 
the scarcity in some measure, there 
were multitudes who received no benefit 
from them. They were two leagues from 
the city. The poor, the sick, and the 
helpless could not travel so far. Many 
of them indeed were unable to buy, 
had the market been held at its accus- 
tomed place, or at their own doors. 
The price of every thing immediately 
rose. Labour became dearer than ever 
was known. The stores of wine, so ne- 
cessary an article of diet to the French, 
were nearly exhausted. Butcher's meat 

{ xxiii ) 

was very difficult to procure upon any 
terms. In short, famine became more 
formidable than the plague itself. The 
original scarcity, bad as it was, did not 
bear a comparison with the hunger, suf- 
ferings, and mortality that resulted from 
these ill-judged regulations. The cala- 
mity of 1720 ought to be denominated 
the famine, rather than the plague of 
Marseilles: for clearly more appear to 
have been starved than to have died in 
any other way. 

" The labouring classes, and those who 
do the work of society for hire, perished 
first; and the greater part of them having 
died, and there being none to replace 
them, it was impossible to get work 
done, even for money. A large pro- 
portion of male and female servants, 
waiters, and laqueys also famished at 
an early period; and it was oftentimes 
ouite out of the power of the most 
wealthy persons to procure domestics to 

( xxiv ) 

perform the ordinary services of life, by 
the highest wages. The survivors were 
obliged to perform their own labour and 
attendance. In the progress of the sea- 
son, many of the butchers, baker?, and 
fishermen yielded their lives to the pres- 
sure of the common calamity. The dis- 
tress of this was sorely felt by all the in- 
dividuals yet alive. Of these, the re- 
maining poor were starving for want of 
their accustomed employment ; and the 
rich, because they could not exchange 
their money for common necessaries. 
The houses, throughout all their apart- 
ments and recesses, were strewed with 
the dying and the dead. All the streets 
were covered with carcases. 1 he grave- 
diggers had disappeared. Undertakers 
and sextons were not to be found. About 
a thousand corpses were daily thrown in- 
to the streets to putrify, until, at length, 
a passenger could scarcely walk without 
treading on them. In some places he 

{ XXV ) 

was obliged to tread on them. In fhe 
public walks, and before the Church 
doors, they were piled up in large heaps, 
men, women, and children. Persons 
of all ages and conditions were under- 
going the process of corruption, as they 
overspread the pavements, and filling 
the atmosphere with their noxious ex- 
halations. And this domestic source 
of pestilential effluvia was itself enough, 
without other agents, to have depopu- 
lated the city. To augment their dis- 
tresses, an opinion was started, that the 
contagion was carried from one person 
and place to another by dogs. Instantly 
a war of extermination was declared 
against these poor animals, and the land 
and the water stank with the septic 
fluids proceeding from thousands of 
them that were killed. This shocking 
condition of things continued until to- 
ward the end of September. And, con- 
sidering these concurring causes of mis- 

( xx vi j 

.-Chief, one is apt to wonder that the 
mortality was limited to fifty thousand. 
It might be reasonably expected, that 
under such circumstances, in a popula- 
tion of eighty thousand, a much larger 
proportion would have been destroyed. 

" Finally, the surviving confessors, 
physicians and surgeons, exhausted and 
discouraged by all they had suffered, and 
by all that they feared, ceased at once, 
to administer their services, and aban- 
doned the wretches to their fate. When 
these men withdrew their attendance, 
and sought their own safety by flight, 
the misfortunes of the miserable inhabit- 
ants were wrought up to the highest 
pitch. They had long endured the 
depressing operation of fear. In many 
the apprehension of danger had been 
changed into ghastly terror. But now 
the small remains of fortitude forsook 
them, and they sunk under the pres- 
sure of dejection and despair. Their 

( xxvii f 

minds and bodies became the prey or u 
debility which ended in languor and 
death, or which predisposed them to 
receive morbid impressions that they 
might otherwise have repelled. The 
dread of the plague, when augmented 
by the horror of desertion by all who 
could administer help or comfort, was 
a fatal aggravation of their woes. 

" These woes, however, had some alle- 
viation toward the termination of the 
calamity. For, during the season of 
Lent, the good Bishop, the celebrated 
Castelmoron, who, by an ordinance of 
24-th February, dispensed with the rule 
of rigid abstinence, and permitted the use 
of meat four times a week, substituted, 
instead of fasting, the recital of certain 
particular prayers. On the 4th of March, 
solemn application was made in the 
Jesuits' Chapel, to St. Francis Xavier, 
for his intercession with Heaven to ar- 
rest the mischief; and on the 21st 

( xxviii ) 

a similar service was performed to the 
sacred heart of Jesus, in the Capuchin's 
Church, for the same purpose, and con- 
tinued in both for nine or ten days. 
Altars were erected in various public 
places, and mass celebrated there. Even 
the ancient custom of carrying the via- 
ticum to the sick in every parish was 
permitted during the fortnight of Easter. 
In like manner a procession had been 
formed on the 31st of December, by the 
Bishop carrying the holy sacraments, 
attended by the surviving clergy, around 
the ramparts. He pronounced the be- 
nediction at the gates of the town, and 
in the ditches where the dead had been 
deposited, to implore the mercy of the 
Lord upon those unhappy defuncts 
whom the calamity had deprived of ec- 
clesiastical sepulture. And, on the 15th 
of the preceding November, the same 
pious prelate had walked bare-footed, 
with a torch in his hand, to an altar 

( xxix ) 

which had been erected in the park, 
and after having celebrated mass, and 
given the consolation of his advice and 
exhortation to the people, he ascended 
to the top of the steeple in the parish 
Church of Accoules, and pronounced a 
blessing upon the whole city at once, 
while the ringing of bells, and the firing 
of cannon notified the inhabitants to join 
their prayers to those of their Bishop. 
It was seriously agitated between two of 
the great churches, whether the relics 
of the saints ought not to be brought 
forth to view; but, owing to a difficulty 
in settling certain points of ceremony and 
etiquette, these sacred treasures were 
not exhibited. 

" This accident, therefore, partook 
much more of a famine than a pestilence, 
since the true causes were; 1. Scantiness 
and badness of food ; 2, An unhealthy 
season among the poor and labouring 
orders; 3. The consternation on their 

( XXX ) 

distemper being proclaimed the true 
Turkish plague; 4. The starving condi- 
tion to which the inhabitants were fur- 
ther reduced by the regulations of the 
police; 5. The envenomed quality of the 
atmosphere, from the rotten bodies of 
unburied men and dogs; 6. The prostra- 
tion and annihilation of animal power 
by grief, despondency, and the most 
depressing passions. And still, notwith- 
standing all these circumstances and 
occurrences, enough in all sober consi- 
deration to desolate a city, it has been 
the fashion, ever since Bertrand's book 
was published, to quote it as the highest 
authority in favour of an imported conta- 
gion that stirred up such complicated and 
unspeakable mischief; mischief which 
derived infinitely more of its fatality from 
bad management, than its own inherent 
malignity. This author has written an 
elaborate and sensible account of the 
sickness and its accompaniments. He 

( xxxi ) 

is as impartial as can be expected in a 
person who is a strong and zealous advo- 
cate for contagion and importation. On 
the occurrence of a more than common 
sickness at Marseilles, it became a sub- 
ject of rational inquiry to discover its 
cause. Mr. Bertrand adopted the belief 
of its introduction from a foreign port, 
and patched up a story about contagion 
brought from Sidon and Tripoli. I say, 
patched up a story, because the exist- 
ence of such contagion has never been 
proved by the evidence of one of the 
senses. The contagion is a mere conceit 
of the mind; and all reasoning upon 
such a visionary and fancied agent can 
be but hypothesis, and have no better 
claim to our assent than the fluid of 
magnetism and the ether of Gravitation. 
Upon such a conjecture, all the public 
proceedings were founded; an assump- 
tion not near so worthy of our assent, as 
if it had been said that the invisible angel 

( xxxii ) 

©f destruction had literally and bodily 
descended, sword in hand, to execute a 
heavy judgment of his Lord. 

" On reading this famous book, and 
comparing and weighing the evidence 
it contains, I am entirely convinced that 
the importing party have failed to sup- 
port their assertions by, I will not say 
logical or legal proof,, but even by that 
evidence which is fit to convince a plain 
understanding here in North-America, 
after a lapse of more than fourscore 

" Are we then to give credit to the 
phantom, which deceived the people of 
France to the destruction of the Marscil- 
lians, and misled their intelligent his- 
torian himself? By no means. Let us 
rather sift the whole testimony, and, dis- 
regarding the erroneous conclusions of 
our predecessors, decide upon the facts 
for ourselves. If we do so, we 'hall find 
the plague of Marseilles, which has been 

( xxxi'ri ) 

quoted and dwelt upon as the clearest 
case of imported contagion that ever ex- 
isted, to be unsupported by the necessary 
evidence, even on the allegations of its 
warmest advocates." 

Having stated thus far a summary 
of the contents of one of the most cele- 
brated works on the importation of plague 
into France, we shall next insert the ac- 
count of its pretended importation into 
Sicily, in 1743. This is taken from 
Dr. MitchuTs letter to Dr. Rodgers, the 
Health Officer of the port of New- 

** Analysis of Turriano's Treatise 
onthe Plague 0/*Messina, in Sicily, 
1743; and an Account of the Use of 
the Rack and Torture to prove the Dis- 
temper contagious. 

" The city of Messina, in Sicily, suf- 
fered a dreadful visitation of sickness in 
1743. An account of it was written by 

( xxxiv } 

Horace Turriano, and published at 
Naples, in 1745, under the title of Me- 
moria Istorlca del Contagio dclla Citta dl 
Messina del Anno 1743. Turriano's 
book contains several particulars well 
worthy of notice. He says that the 
spring of the year which preceded the 
pestilence was rough and cold. South- 
erly winds prevailed, which were stormy 
and cloudy. The cold at the time of 
the equinox was scarcely less than that 
of the preceding winter. But the winds 
continued to blow from the same quar- 
ter, and an epidemical catarrh began to 
prevail among the people. Soon after 
an alteration was perceived in the type 
of the ordinary diseases of the place. 
This new form of the usual distempers 
manifested itself in coughing, hoarse- 
ness, pain in the breast, swellings of the 
throat and glands of the neck, with other 
symptoms of the true and spurious an- 
gina. In some there were swellings of 

\ XXXV ) 

the glands in the groins and near the 
ears, and fevers wore a malignant aspect. 

" Some of their prophets had foretold 
a sickly season, and now they began to 
apprehend a mortal epidemic, similar to 
those which, at different times, had af- 
flicted Genoa, Alexandria, Milan, Naples, 
Rome, and other places. 

" In this state of things they made a 
discovery, which satisfied all their minds 
what the true cause of this sickness was. 
It was established to their satisfaction, 
that a Genoese tartan, under Neapolitan 
colours, had arrived at Messina, after a 
passage of thirty days, from Missolongo, 
in the mouth of the gulf of Lcpanto, 
opposite to Cephalonia. She brought 
wool, wheat, and some fine manufac- 
tures of the Levant. She had a clean 
bill of health, but had lost one of her 
crew on the voyage. The survivors were 
well. She had had no communication 
with any other vessel or port since she 

( xxxvi ) 

sailed. And the Captain declared that, 
the man had died of an ordinary dis- 
ease, caused by fatigue on a disastrous 
and tempestuous voyage. She was ad- 
mitted to quarantine; and while the 
wool was unloading, the Captain, ex- 
posed to the sickly atmosphere on shore, 
fell sick with an erysipelas of his face, 
and died on the third day. Two days af- 
ter, another man, who had been ashore, 
also became sick on his return to the 
tartan, and died with a swelling in 
the arm-pit, and petechias all over his 

" A consultation was held by the 
magistrates and physicians on the alarm 
occasioned by these accidents, and the 
tartan, and all her contents, except the 
men, ordered to be carried to a remote 
place and burned. Ad the other people 
continued well. 

" The full quarantine of forty days 
being performed, and Te Deum sung, 

( xxxvii ) 

an alarm was given that, in another pant 
of the city, a disease prevailed, accom- 
panied with buboes and other pestilen- 
tial symptoms. The physicians sent to 
examine the sick reported, that the 
distemper was nothing more than the 
epidemic which had prevailed since 
February. They grounded their opinion 
upon the fact, that it was not conta- 
gious, and did not spread from person to 
person. Therefore it could not be the 
plague, whose essential character, they 
said, it was to be in the highest degree 
contagious. Physicians, surgeons, con- 
fessors and barbers escaped it, though 
they attended the sick in hospitals. And 
the like immunity bad happened in the 
malignant sickness at Bronte and Modica 
some time before. The distemper, how- 
ever, went on to increase with so much 
violence and mortality, that on the 4th 
of June it was allowed by all parties to 
be the true plague. 


( xxxviii ) 

" The story of its introduction by the 
before-mentioned tartan, was not now 
deemed sufficient, in the judgment of 
the magistrates of Messina, to prove the 
introduction of the plague. They there- 
fore apprehended two sailors, belonging 
to another vessel, a suspected pink. By 
threats of torture, and the sight of the 
rack, a confession was extorted from 
them of the arrival of the pink at the 
port of Messina, after a coasting voyage 
to Modon, Patras, Missolongo, and other 
places. The contagion was brought on 
board in some rolls of tobacco, or bags 
of biscuit; and after having destroyed 
several persons belonging to the pink, 
was landed among the unfortunate Mes- 
sinians. Being completely satisfied with 
this fo?ccd story, which was modified by 
the engine of terror so as to answer 
every purpose they wished, they re- 
nounced the first one as erroneous and 

( xxxix > 

v The plague continued with but little 
abatement of its fury, notwithstanding 
the relics of St. Lucia and St. Bernard 
were sent to Messina from Syracuse to 
stop it, until the 2d of July, when the 
people took down from the great altar 
the ancient image of their tutelary saint, 
the Holy Mary, the mother of God, 
and carried it in procession through the 
streets. From that day the plague be- 
gan to decline, after numerous other 
processions had failed, and other saints 
been applied to in vain. 

" As soon as the sickness was declared 
to be the plague, the inhabitants were 
panic-struck. There were no bakers to 
prepare bread. There were no labourers 
to dig graves. There were no nurses to 
attend the sick. And as the distemper 
was deemed contagious every person 
was afraid to touch another, and even to 
approach him. The people of the sur- 
rounding country refused to bring fuel 

( xl ) 

or provisions to market, and guarded the 
roads leading out of town with so much 
strictness as to prevent the flight of the 
unhappy citizens into the country. The 
putrefying carcases of the dead lay scat- 
tered through the houses, heaped up in 
the streets, and piled in larger collec- 
tions at the church doors. These were 
so dangerous and shocking, that, at 
length, the furniture and wooden work 
of houses were carried into the streets for 
making fires to burn them. From these 
funeral piles fire was several times com- 
municated to the neighbouring build- 
ings. And by those direful consequences 
of the opinion entertained by the Franks, 
of the contagiousness and importation of 
the plague, the Messinians, instead of 
losing a few hundred persons, as they 
might have done by proper regulations, 
managed matters so badly as to destroy 
above forty thousand lives that season. 
The Turks judge more like rational 

( xli ) 

creatures about this disease, and do not 
frighten, starve and poison themselves 
to death on account of it. 

" After the abatement of this calamity, 
so great a part of which was brought 
upon themselves by their own impru- 
dence, they concluded that a general 
purification was necessary to restore to 
health their city, contaminated by con- 
tagion. 7\) superintend this grand ope- 
ration, the famous Dr. Polacco was sent 
for from Venice. And under his eye 
they went from house to house, and, 
after various washings, ventilations, and 
other processes, concluded by fumigat- 
ing with mixtures of pitch, brimstone, sal 
ammoniac, frankincense, storax, harts- 
horn shavings, raspings of pine, juniper- 
berries, dried rosemary, old leather, long 
pepper, camphor, gun-powder, orpiment, 
and antimony. And this ceremony be- 
ing over, the surviving inhabitants re- 
turned to their homes, as fully convinced 
c 2 

( xlii ) 

that the perfumery had destroyed the la- 
tent contagion, as that the image of the 
Virgin had stayed its ^active malignity. 

" Professor Thomas Fasano judged 
better on this subject. He published a 
book at Naples on the epidemic fever 
which desolated that city in 1764-. It is 
entitled, Delia Febbre Epidemica sofferta 
in Napoli I 'Anno 1764. Libra iii. Dl 
Tomasso Fasano. He is so wholly con- 
vinced of local and domestic origin, that 
he does not even mention any thing 
about a ship. And this, in a sea-port, is a 
very remarkable circumstance. Fasano, 
with great good sense, lays it down as a 
principle, that an epidemic is a slight 
plague, and that the plague is a powerful and 
furious epidemic, (che l'epidemia fosse 
un leggiera peste, e la peste un' epidc- 
mia gagliarda c furiosa.) And, in like 
manner, Michael Sarcone, who wrote 
an history, in two volumes, of the dis- 
tempers which prevailed at Naples in 

( xliii ) 

17G4, under the title of htoria Ttaggio- 
nata de Mali osservati in Napoli neW in- 
tcro corso dell' Anno 1764, does not pre- 
tend that this epidemic was any thing 
else than a pestilence consequent upon 
the extreme scarcity and famine of the. 
preceding year. 


Introduction 1 

Meteorological observations, temperature, weight 
of the atmosphere, direction of the winds, and 
state of the sky during the year 7 (1798-9) at 

Cairo 11 

Observations on the diseases which attacked the army 
of the E ist in Egypt and in Syria, during the years 
6 and 7 (4798-9) of the French Republic, contain- 
ing an investigation of its identity with the plague 13 
Whether this disease be really contagious - 16 

Of the symptoms accompanying this disease - 26 
Of the causes which could have produced this disease 

in Egypt and Syria 35 

Indications of cure 42 

Treatment - - ib. 

Of buboes and gangrenes, known under the name of 

carbuncles or anthraxes - - - 51 

Of the means to be used for preventing the attacks 

of this disease - - - - 56 

Of the means which might be employed in Egypt to 
destroy th« epidemic fevers 68 

( xlvi ) 

Of the seclusion of the Franks during the time of 

the plague - 73 

Of lazarettoes and quarantines - 7d 

Reflections on the epidemic fever observed in the 

Ligurian Republic, and in the hospitals of the 

army of Italy, in the year 8 (1799 1800) - 89 

Reflections on the yellow fever which appeared at 

Cadiz in the year 1800 - 93 

Symptoms - 94 

Causes ... - 95 

Method of cure - - . - - 97 

Means of prevention - 100 

Queries respecting the yellow fever which appeared 

at Cadiz in the year 1800 - - 101 

On the dysentery - 104 

Treatment, and means of preventing this disorder 108 
On the ophthalmy of Egypt - - 116 

Description of the ball of the eye - - 117 

Description of the ophthalmy - - 123 

Causes - - 125 

Indications - - - _ 132 

General treatment of the ophthalmy - 133 

Treatment of the simple ophthalmy - - 136 

Tx-eatment of the complicated ophthalmy - 139 

The treatment used by the Egyptians for the cure of 

the ophthalmy - 145 

Powders, ointments, and collyriums used in Egypt 

in the treatment of the ophthalmy - 148 

On the means of preventing the ophtha'my - 150 
Description and plan of an hospital for soldiers 

attacked in Egypt with the disease called the 

plague, &c. . 155 

( xlvii ) 


Report made to the Society of the School of Medi- 
cine at Paris .... 176 

Report made to the Consuls ot the French Republic, 
by the Minister of War, the 15 Germinal, year 
9 (4th April, 1601) 196 

Additional Notes - - 199 

Appendix. Concerning the Seasoning, or Yellow 
Fever of ihe West-indies - - 21t 


Xl/VVING been appointed to attend the 
grand park, of artillery during the expedi- 
tion to Syria, in the rank of medical officer, 
I arrived at Jaffa on the 15th Ventose, in 
the year 7 (the 6th March, 1799), and on 
the 18th (9th), I took the charge of the 
hospitals in that city. 

Forty days afterwards I received order? 
to follow into Egypt General Damas, and 
several other soldiers, who had been se- 
verely wounded ; the unhealthiness of the 
country and other circumstances requiring 
that measure. On our return to Damietta 
the citizens who composed the board of 
health there considering us to be affected 
with the plague, put us under strict qua- 
rantine. To beguile the ennui of my prison, 
I resolved to commit to writing (although 

( 2 ) 

in a foreign language) the observations 
which I had made on the disease which was 
the cause of ohr seclusion. I employed my- 
self successively in this way during the dif- 
ferent quarantines which I afterwards un- 
derwent at Cairo, at Malta, and in the 
lazaretto of Marseilles. These opportuni- 
ties of observation led me to entertain 
doubts respecting the cause of the plague, 
and to form conclusions that have not been 
generally adopted; which scepticism, con- 
joined with the peculiar circumstances in 
which I found myself placed during mv re- 
sidence in the Levant, have furnished me 
with evidences and facts which will contri- 
bute, in my opinion, to discover the real 
causes of the disease of Egypt, called the 
plague. This object will be the more easily 
attained in proportion to the attention paid 
by the respectable general officers, the well 
educated medical staff, the natural philoso- 
phers, geologists, and other philosophical 
men attached to the colony of Egypt. 

I have also added some particulars re- 
specting lazarettoes, the seclusion of the 

i 3 ) 

Franks in their own houses during the 
plague, the dysentery, and the ophthalmy. 

Before we treat of these diseases, it will 
not be improper to give some idea of the 
circumstances which contributed to impair 
the health of our soldiers on their arrival 
in Egypt. 

On the 16th Messidor of the year 6 (5th 
of July, 1798), after a voyage of forty-five 
days, the army of the East landed at Alex- 
andria, in the best possible state of health, 
notwithstanding the inevitable inconveni- 
ences resulting to land troops from a sea 
voyage. On our arrival at Alexandria, we 
were encamped upon a dry, barren, and 
scorched soil: the thermometer stood at 
mid-day at 26° (82° Fahrenheit), the nights 
were cool; but the immense quantity of 
gnats or musquitoes prevented sleep by their 
punctures, which threw the skin into a 
state of inflammation resembling the mea- 
sles. It would be difficult to express the 
painful sensation which these insects pro- 
duced at the moment when they thrust their 
stings into the substance of the skin, 

( 4 ) 

The army, not finding a sufficient quan- 
tity of fresh provisions in Alexandria, was 
obliged to continue to draw its supply 
from the fleet. This food was far from be- 
ing of the best quality ; the water likewise 
in the cisterns of Alexandria was scanty, 
muddy, and of a taste by no means plea- 
sant to people just arrived from Europe. 
At this time also the nights were not only 
cool but damp; the ground was moist at 
day-break, as if there had been a fall of 
rain; winds from the south-west quarter 
prevailed: the vapours of the sea, and the 
exhalations of the lake Mareotis, which 
was not yet dried up, contributed to render 
a residence at Alexandria very unhealthy, 
particularly at this season. In short, Alex- 
andria had just been visited with the plague, 
and the Franks lived still shut up in their 

By the 18 Messidor (7th July), the whole 
army was on its march for Cairo. As we 
had not been accustomed in Europe to 
trouble ourselves with live stock, nor to 
carry a supply of water with us, we neg- 

( 5 ) 

Jected these precautions; but what suffer- 
ings did we not endure during our march 
from Alexandria to Rhamanieh, across a 
country become a perfect desert, since, 
through the negligence of the ancient go- 
vernment, it is not now reached by the 
waters of the inundation? Having at length 
arrived at the Nile, we had the means of 
quenching the burning thirst which great 
fatigue had rendered the more insupport- 
able. Continuing our march along the 
banks of this river, we frequently met with 
fields of pastequss, or water melons; and 
daring the remainder of our march to Cairo, 
these delicious fruits continued to furnish 
the most delightful and agreeable repasts, 
and produced k surprising effect on the 
health of our soldiers. 

The army, after having gained the fa- 
mous battle of the Pyramids, arrived on 
the 2d Thermidor (21st July), at Giseh, 
and on the 4th (23d), at Cairo ; where we 
found plenty of bread, meat of every kind, 
milk, eggs, fish, greens, and excellent 
grapes, at a moderate price: wine was 
B 2 

( 6 ) 

scarce, but brandy and coffee supplied its 
place. The heat at Cairo was greater by 
three degrees than at Alexandria, the ther- 
mometer standing at 29° (86°); and to- 
wards the end of Thermidor (middle of 
August), it got up to 31° (89° Fahrenheit). 
The Nile continued sensibly to overflow; 
and on the 1st Fructidor (19th of August), 
the dikes of the Calich were cut to allow 
the waters to enter into the squares and 
gardens of Cairo: on the whole, the inun- 
dation was considerable. 

At the beginning of Vendemiaire, in the 
year 7 (the latter end of September, 1798), 
the thermometer was at 23'° (75°) at mid- 
day, and during the night at 17° (64° Fah- 
renheit), although but a few days before it 
had been at 31° (89° Fahrenheit) at noon, 
and during the night at 22° (74° Fahrenh.) 
This change of temperature of course sub- 
jected our soldiers to diseases, because they 
were not yet accustomed to the climate, 
and unacquainted with the necessary pre- 
cautions. The soldiers of the divisions on 
actual service always passed the night in 

( 7 ) 

the open air, or, if on the Nile, slept in 
open barks, whilst those in garrison, in 
order to profit by the coolness of the night, 
slept constantly out of their quarters, or 
close to large windows thrown open, where 
they were exposed to the north wind : 
the perspiration was thereby checked, and 
gave rise not only to rheumatic affections, 
which are very common in Egypt, but like- 
wise to the dysentery and ophthalmy. If 
to these positive causes be added the mi- 
asmata exhaled by the numerous marshes 
in Lower Egypt, we shall possibly disco- 
ver the real source of the epidemic fevers 
which are known by the name of the 
plague, those of Jaffa having been of the 
same nature. Before we treat of these, it 
may not be amiss to describe the medical 
topography of that city, and to point out 
the particular circumstances which contri- 
buted to develope a disease that proved 
more destructive there than in any other 

. Jaffa, or Joppa, the small sea-port town 
of the ancient Palestine, upon the Mediter- 

I s ) 

ranean, is situated on an eminence, and 
built in the form of an amphitheatre, in 
northern latitude 32° 20', and in 52° 55' of 
longitude from the meridian of Paris. The 
sea washes its walls on the north and the 
west: several very extensive woods, com- 
posed of an innumerable quantity of bushes, 
orange, citron, and other fruit trees, cover 
this city on the south and the east sides^ 
The chain of mountains which stretch from 
north to south, oppose a barrier to the 
clouds brought by the winds from the west 
and north, and give rise to the formation 
of thick mists and heavy rains, which take 
place in this part ot Syria during the winter 
and spring. The nature of the soil, and 
the want of ditches and canals to drain the 
ground, occasion several ponds or marshes,, 
which can only be carried off by evapora- 
tion. The French army, on its arrival at. 
Jaffa, encamped close to three of these 
ponds, the waters of which supplied their 
wants till their departure for Acre. 

On the taking of Jaffa by assault, the 
number of Turks killed and half buried :; 

I » ; 

the bodies of those whom the sea threw 
back, and left on the shores ; the miasmata 
arising from the putrefaction of the car- 
cases of the horses and camels left dead 
upon the ground, or dragged scarcely be- 
yond the walls ; the want of fresh provi- 
sions ; the filthiness of the inhabitants ; the 
hordes of Bedouin Arabs who blockaded 
the city; these circumstances conjoined, in 
a few days overwhelmed us with all the 
miseries of war, famine, and pestilence. 

The resemblance between several of the 
diseases observed in Europe, and the epi- 
demic fevers of Egypt, has induced me to 
say a few words on that which showed it- 
self in the Ligurian Republic in the year 8 
(1799—1800), and upon the yellow fever 
which broke out at Cadiz in the year 9 
j(1800, 1801). 

Some epidemic diseases are rendered 
contagious, by merely bringing together a 
certain number of individuals into the same 
place, and particularly in badly ventilated 
hospitals. In order to avoid this inconve- 
nience, I have conceived the design of an 

( io ) 

hospital for the garrisons of each principal" 
city on the coast of Egypt. It appeared to 
me to unite several advantages, and I have 
had the plan engraved. I have also added 
some details relative to service, and the oily 
frictions, as practised in different cities in 
the Levant, but particularly at Smyrna, in 
the treatment of the plague. I submit the 
whole to the judgment of my fellow prac- 
titioners, that they may extract from it in- 
formation towards attaining a knowledge of 
the mode of treating the disease, preserving 
the health of the medical officers and those 
employed in the hospitals - y and to prove 
that the epidemic disease of the coast of 
Egypt is not always the plague. 

Sat mini, si prosim, scribendi magna voluptas. 

( 11 ) 




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( 13 ) 



Which attacked the Army of the East in 
Egypt and in Syria, during the Years 
6 and 7 (1798, 1799) of the French 

1 AM at a loss what name to give to a 
disease which attacks several individuals at 
the same time, and the chief symptoms of 
which are fever, buboes, partial gangrenes, 
or carbuncles, prostration of strength, head- 
ach and delirium, and which generally 
carries off the patient on the third or fifth 

This disease, which every year shows 
itself more or less along the coast of the 
Mediterranean and Archipelago, from Alex- 

( 14 ) 

andria to Constantinople, has been named 
the Plague. The Europeans, who have 
been long settled in the Levant, as well as 
those who practise medicine in Egypt and 
Syria, have called it the plague; and, rela- 
tively to the number of its victims, they 
style it, the mild plague, or the malignant 
plague. Prosper Alpinus informs us, that 
the plague is brought into this country 
along with the merchandise coming out of 
Greece, Syria, or Barbary. He asserts, 
that the plague which comes from Greece 
or from Syria to Cairo, is mild, and of short 
duration; whilst that which comes from 
Barbary is fatal, and lasts a longer time; 
that this disease shows itself at the com- 
mencement of September, and constantly 
ceases in June, whatever may be its vio- 
lence. The Europeans and the inhabitants 
of the Levant, settled in Egypt and in 
Syria, look upon the eve of St. John as 
the last day of the plague for that season. 
Those who are persuaded that this malady 
can only be contracted by contagion, not 
-being able, to impute the cause of the pesti- 

( 15 ) 

lential disease which appeared amongst our 
troops to the arrival of any vessel from 
abroad, on account of the blockade by the 
English squadron, have pretended to attri- 
bute it to goods which, since the year before, 
had been left infected in the magazines of 
Alexandria and Damietta. As it is an opi- 
nion commonly received, that the pestilen- 
tial virus adhering to some stuffs remains in- 
active during the heats of summer, but that 
in winter it recovers its former activity, and 
causes the plague to burst forth anew; 
others have thought that this malady had 
existed during the whole year at Alexan- 
dria, although it did not show itself in 
several individuals at the same time till the 
winter season. Those who have employed 
themselves in investigatin°: the nature of 
this disease, agree in saying, that the poi- 
son of the plague is an unknown, invisible 
vapour, which comes from distant countries, 
and is communicated by actual contact 
from one body to another, exerting its de- 
structive powers on persons of every age 
and temperament. As to myself, I avow. 

( 16 ) 

that I cannot form any idea of this vapour, 
The medical officers of the army of the 
east, not meeting with all the characteristic 
symptoms of the plague in this disease, 
called it the fever with buboes. Savaresi, 
the physician in ordinary to the army, dis- 
tinguished it into the si/nochus, simplex, 
tymphaticus , lymphaticus pestilentialis, and 
typhus graviov. A great number called it 
the prevailing disease ; but I preferred call- 
ing it the epidemic fever, that I might not 
make use of the denomination of the plague, 
a name full of terror, and often more mor^ 
tal than the disease itself. 

Whether this disease be really contagious ? 

Contagion has been distinguished by au- 
thors into volatile contagion and fixed con- 
tagion. The plague, which is certainly of 
all diseases the most severe and most fatal, 
has been supposed to arise from fixed con- 
tagion; and, according to the established 
principles of lazarettos, it has been judged 
^sufficient to avoid immediate contact to es~ 

( w ) 

cape the plague, and that hindering all 
communication will arrest its progress: 
without this precaution, they pretend that 
the disease is communicated, and propa- 
gates itself from one country to another. 

I have seen a great number of persons 
who have been attacked by the epidemic, 
after having had communication with others 
who were already sick; and I would have 
adopted the conclusion, that it was to the 
contagion they ought to attribute their dis- 
ease, if I had not also seen a much greater 
number who continued to enjoy good health, 
in spite of the most decided communica- 
tion. I have even seen several individuals 
contract the disease, and die, although 
they had been living shut up, according to 
the manner of the Franks. I should have 
thought it right to conclude, that the dis- 
ease of which we are now speaking was 
contagious, had I seen the Egyptians and 
Syrians fall under its influence as well as 
our soldiers, with whom they had constant 
intercourse. As soon as any one of our men 
was attacked, two Turks led or carried 

( 18 ) 

liim to the hospital. There is no doubt 
that several of them shared the clothes of 
infected persons, without contracting the 
disease. If it had been contagious, as is 
pretended, it would not have been possi- 
ble to have arrested its progress in Lower 
Egypt, nor to have hindered its spreading 
to Cairo. The lazaretto established near 
Boulac was at that time of very little use 
towards effecting so important an object. 
It is well known, that the fear of quaran- 
tine only caused the inhabitants to devise 
schemes to elude the vigilance of the guards 
of health, and custom-house officers. Seve- 
ral Frenchmen and superior officers coming 
from Alexandria and Damietta by the Nile 
to Cairo, to avoid being detained for five 
daysin quarantine, landed, with their horses, 
about a league from Boulac, and entered 
Cairo without performing it. How many 
pacquets and letters coming from Alexan- 
dria and Damietta, where the disease was 
raging, entered Cairo without producing 
any bad effect! What I have just said of 
the soldiers coming from Lower Egypt will 

( 19 ) 

apply to those who came from Syria, where 
the same disease had broken out.* 

In the month of Floreal (April, May) 
three soldiers coming from Bekaire-Tel- 
Agy, a fort situated three leagues from 
Cairo, where this disease had shown itself, 
were conducted to the hospital of Ibrahim 
Bey : they died two days afterwards. These 
men had intercourse with more than sixty 
persons. The committee of health gave 

* On his return from Acre, I attended the General of divi- 
sion Lasnes, wh 1st he was still under quarantine in the isle of 
Roda. I extracted a musket ball, which had struck him in the 
temple, below the left eye, and which, passing along the tem- 
poral bone, had buried itself behind the ear. A little instru- 
ment which 1 had invented for making counter openings, was 
of great use to me in this operation, as it helped me to discover 
the ball, which was supposed to have come out at the ear, 
where there was an opening which poured out a good deal of 
blood at the time of the wound. This instrument directed me 
to the ball, without making useless probings or incisions. Sooa 
after the arrival of this General at Roda, on being called in 
consultation, I extracted this ball, which had been so difficult 
to discover, that it had remained in that position during thirty- 
^even days. 

It was in the breach at Acre that this brave officer received 
this dangerous wound : he immediately fell senseless ; and his 
soldiers, believing him dead, brought him off from the battle, 
by dragging him by the feet for upwards of two hundred paces, 
that his body might not be left in the hands of the Turks. 
Twenty days afrer my operation, he chose, in opposition to 
my advice, to follow General Bonaparte to Aboukir, where 
he contributed greatly to the memorable defeat of the whole 
army of Mustapha Pacha. At this time he is commander ia 
chief of the consular guards at Paris. 

( 20 ) 

it as their opinion that they died of the 
plague, and ordered this hospital to be put 
under a strict quarantine; during the course 
of which not a symptom of the plague oc- 
curred, nor even a single death; although 
just before there had died more than two 
every fortnight. 

After the death of several medical offi- 
cers at Jaffa, General Grezieu, command- 
ing this province, recommended to the com- 
missary of war, a native, who had the re- 
putation of being an excellent physician for 
the plague: it was agreed that he should 
prescribe under the inspection of a French 
surgeon. This man opened the buboes in- 
discriminately, his knowledge in medicine 
not being extensive. For several years he 
had attended such inhabitants of Jaffa as 
were attacked by the plague, and he used 
no precaution whatever to preserve himself 
from this complaint, nor to avoid contact. 
I have seen him get up with his bare feet 
on the bed of General Grezieu, covered 
with sweat, and take him by the arms to 
change his posture, although he was then 

( 21 ) 

attacked with a carbuncle, of which he 
died an hour afterwards. When he had 
opened the buboes with his bistoury, he 
took a bit of lint, or a little charpee, to 
wipe it, after which he placed it between^ 
his forehead and his turban: he went in this 
way from one patient to another, not only 
in the hospital, but even throughout the 
city, and did not put it back into his case 
until his visits were over. Citizens Des- 
genette and Larray, the one physician, the 
other surgeon in chief to the army of the 
east, as well as several others of my col- 
leagues, exposed themselves as much to 
the contagion without suffering any incon- 
venience. It would be tedious to mention 
here all the particulars. Citizen Larray, 
besides the operations practised in this dis- 
ease, opened several of the dead bodies, 
and examined with great attention all the 
parts, but particularly the buboes, and the 
state of the lymphatic glands, all of which 
were in general found more or less enlarged. 
Citizen Desgenette pointed out to me two 
punctures, which he had made on himself, 

( 22 ) 

while in Syria, with a lancet dipt in the pus 
of a bubo: he made this inoculation, per- 
suaded that the disease was not contagious, 
and both of these learned and zealous staff 
officers have continued to enjoy good health. 
The Commander in Chief, Bonaparte, great 
in every emergency, braved, on several oc- 
casions, the dangers of the contagion. I 
have seen him in the hospitals at Jaffa, 
inspecting the wards, and talking familiarly 
with the soldiers attacked by the epidemic 
fever and buboes: a conduct which pro- 
duced the best effect, not only on the spirits 
of the sick, but of the whole army. This 
heroic example encouraged at the same 
time the hospital attendants, whom the 
progress of the disease, and the fear of con- 
tagion had alarmed considerably. I know 
that the advocates for contagion cite exam- 
ples of persons and very large families who 
have died, because they had touched the 
sick, or the effects belonging to them, which, 
in their opinion, contained the germ of the 
disease: but they do not foresee, that it 
would result from this reasoning, that what 

( 23 ) 

they say of this disease may be said of the 
opthalmy of Egypt, the fevers of Mantua, 
and, in fine, of all epidemics. 

Daring the 2d year of the Republic 
(1794), ten thousand men perished in the 
space of four months in the army of the 
Pyrenees, comprising almost all the medi- 
cal officers, and hospital attendants. In 
the year 3 (1795), and in 7 and 8 (1799, 
1800,) the same calamity befel the army 
of Italy in the bay of Genoa, and in the 
environs of Nice. Luckily, not discover- 
ing buboes, they did not pronounce it the 
plague, nor contagious, although the mor- 
tality was such, that a great many soldiers, 
and some entire families, fell victims to the 
same disease. (See the Journal de Medi- 
cine, an. 9, page 373). The campagnia 
of Rome, the environs of Perpignan, the 
departments of l'Ain in France, Hungary, 
Guinea, Bengal, and other countries, both 
in Europe and elsewhere, present spots 
where fevers show themselves, which make 
considerable ravages, and which are ac- 
knowledged to be epidemic, without being 

( » ) 

contagious, and mortal without being consi- 
dered the plague. Lind, in speaking of Ben- 
gal, says, that in the rainy seasons malignant 
fevers are contracted, which prove immedi- 
ately fatal; the body becomes covered with 
livid spots, and the corpse black in a few 
hours. If these diseases be neither conta- 
gious, nor the plague, why give this terrible 
name to the epidemic observed in Egypt and 
"Syria, and assert it to be contagious? One 
may contract, in my opinion, this disease, 
when the causes which produce it shall by 
degrees have impaired the health, and pre- 
disposed the body to take on diseased ac- 
tion: I will then admit, that if a person be 
exposed to breathe the infected air in the 
chamber of a patient, or should he stay too 
long in the same atmosphere, he will run 
a great risk of contracting the prevailing 
malady. I have been careful never to stay 
longer by the sick than the time requisite 
to perform the necessary operations ; after 
which I always went out to respire a better 
air. In this way I have been preserved 
from a disease which, in forty days, carried 

( 25 ) 

off one third of the garrison of Jaffa, in- 
cluding the commandant of the province, 
the governor of the plate, and nine medical 
officers. I experienced a real satisfaction, 
when I approached the sick and felt their 
pulse, whether to learn their situation, or 
to endfrfcrage them by assuring them that 
they ha'cUnot the plague. How often have 
I seen them resume their courage and re- 
cover, after this assurance, and some ad- 
vice, which acted more on the mind than 
on the body! Among our operations in 
these cases, bleeding required, more than 
all others, our close approach to the patient 
and his bed, because it is impossible to per- 
form it at a distance. For my own part, I 
followed the common method, without tak- 
ing any precaution, except that of avoiding 
the patient's breath. In opening the bubo 
of an officer, the pus and corrupted blood 
spouted out on the back of my hand. I 
have slept in sheets which, without my 
knowledge, had been washed by a female 
patient who died the day after: She was 
the daughter of the consul of Ramie. A 

( 26 ) 

young German, the wife of one of our sol- 
diers, came to consult me at the hospital, 
during my absence: she laid herself on my 
bed a quarter of an hour: I went to visit 
her on the following day at her own house, 
and found her expiring. I confess, that 
these and other similar accidents did not 
contribute to render me more tranquil ; but 
I had made up my mind: besides, I was 
at my post. 

I will leave to those who believe this 
disease contagious, the trouble of explain- 
ing all these facts, and many more, well 
known to the army of Syria. The conser- 
vators of health, and those employed in 
lazarettoes, will be pleased to observe, that 
I speak of the disease which showed itself 
during the years 6 and 7 (1798, 1799), in 
Egypt and Syria, and not of the plague. 

Of the symptoms accompanying tin's disease. 

An universal debility, accompanied by a 
great weight in the head, is a constant pre- 
cursory symptom. The countenance has a 

( 27 ) 

particularly stupid look, difficult to be de- 
scribed. If the patient be of a sanguine 
temperament, and of a fine skin, his ap- 
pearance becomes bloated, and his colour 
of a redish purple ; the minute vessels of 
the tunica conjunctiva become turgid with 
blood, as at the commencement of a slight 
ophthalmy: the patient in this state does 
not leave his usual occupations, but endea- 
vours to keep on his trembling legs, al- 
though obliged often to have recourse to 
some object for support : he yawns fre- 
quently, rubs his face, and at last retires to 
lay himself in some solitary place, where 
he covers his head, and gives himself up to 
sleep. If in this state he be left without 
assistance, his pulse becomes more quick 
and frequent, the heat of his skin more in- 
tense, and the universal debility greater. 
If interrogated, he stammers out a reply; 
his ideas become confused, and on the third 
or fifth day he dies delirious. Amongst the 
symptoms which were observed to precede 
this disease, there was a general affection 
of. the nervous system, loss of appetite, 

( 28 ) 

slight inclinations to vomit ; the tongue 
rarely showed any marks of derangement 
in the stomach; the stools became altered 
and liquid; the urine resembled distilled 
water; the glands of the groins and arm- 
pits, rarely those of the neck, became pain- 
ful and swelled, and gave rise to buboes. 
In general, the whole lymphatic system ap- 
peared affected. Often small black spots 
showed themselves on the skin, which be- 
came perfect gangrenes. The dead bodies 
did not in general present any external 
change worthy of remark ; sometimes there 
were found ecchimoses, or livid spots, on 
the parts of generation, and on those parts 
on which the body rested. Nothing very 
extraordinary showed itself in the internal 
parts; the lymphatic glands alone were 
particularly affected. This malady was 
very mortal in Egypt, and especially in 
Syria: one third of those attacked died in 
the early stage of the disease, the majority 
with buboes. Sweats were favourable, and 
carried off the fever; speedily after which 
the buboes disappeared; sometimes thev 

( 29 ) 

came to suppuration, which rendered the 
disease and the convalescence very linger- 
ing. Carbuncles and gangrenes were bad 

Of the inhabitants of Jaffa who perished 
by the plague, a great number were infants-, 
very few women, some men, almost all 
strangers. In general, the temperament 
and constitution of body, state of the fluids, 
age and sex of the patient, the season, 
the air, the winds, situation, the fear of 
death, and all the affections of the mind, 
modified this disease more or less. Persons 
of a full habit, infants with a fine skin and 
flaxen hair, young people of a sanguine 
temperament and irritable fibre, were more 
liable to the disease than those advanced in 
age, or of a dry and bilious temperament. 
Such is my own habit of body ; and I have 
no doubt that it was the cause of my en- 
joying health in the midst of so many dan- 
gers. After seeing a certian number of 
sick, I could not only distinguish at a glance 
their disease, but I was very rarely mista- 
ken in my prognosis. I advised individu- 

( 30 ) 

als, in other respects well and robust, to 
Jeave Jaffa, on account of their tempera- 
ment. I encouraged, on the contrary, 
many others, because they were, in my 
opinion, of a constitution and temperament 
which rendered them fit to resist the influ- 
ence of the disease. The following parti- 
culars will perhaps appear minute ; but on 
the subject of so remarkable a disease, I 
think that trifling remarks, supported by 
facts, may be of some utility. 

Immediately after the plague had mani- 
fested itself in Jaffa, Citizen Engelfret, and 
his partner, two French merchants, esta- 
blished and known for several years in 
Egypt and Syria, shut themselves up alone 
in their own house; the one was of a full 
moist temperament, the other meagre, and 
of a dry fibre: they were persuaded that 
seclusion and perfumes would preserve them 
from this malady, which they believed to 
be the plague. After some days I per- 
ceived that the latter began to contract the 
colour and appearance of a person about 
to fall sick, I communicated my suspicions 

( 31 ) 

to Engelfret, and advised him to quit their 
damp abode. Two days after, that very man 
was attacked with a violent head-ach, ac- 
companied with fever and buboes, and died 
on the third day in the arms of his friend, 
I encouraged the affrighted Engelfret, who, 
in consequence of the contagion, thought 
hiirself gone: he confided very much on 
the knowledge I had of his temperament, 
which appeared to me a complete protec- 
tion from the disease. The same thing 
happened a little time after to Citizens 
Malus and Bringuer; the one chief of a 
battalion, and the other captain of engi- 
neers : both were attacked with the same 
disease. The first, who was of a bilious 
temperament and delicate constitution, re- 
covered; but the second, who was san- 
•guine, robust, and of a strong constitution, 
could not survive it. 

Being sent for to the tent of General 
Boyer, and of Citizen Amelin, encamped 
without the walls of Jaffa, to avoid all 
communication with the city, I saw Citi- 
zen St. Simon, knight of Malta, and mem- 

( 32 ) 

ber of the institute of Egypt, severely at- 
tacked with the disease: I immediately- 
despaired of his life: he died two days af- 
terwards. I assured, at the same time, 
Citizen Amelin, that his interpreter would 
recover, although he had, besides the head- 
ach, pain and swelling of the glands of his 
groins. Having had an attack of the 
plague the preceding year, he was very 
much alarmed at having it again. I caused 
him to be put into my servant's room, and 
I had some excellent warm punch prepared 
for him: I recommended him to cover him- 
self well to bring on sweating. Two days 
after he was able to return, in company 
with his master, to Cairo. 

The keeper of the store-house at Jaffa, 
a man of full habit and moist temperament, 
was one of those who was the longest in 
falling ill. He assumed an air of plea- 
santry when one spoke to him about pre- 
cautions. One day, seeing him yawning, 
rubbing his face, and looking sorrowful, I 
did not hesitate to foretel to Citizen Villersy 
commissary of war, with whom I was then 

( 33 ) 

walking, that it was all over with the store- 
keeper. I was called the same day to go 
to see him: I found him so completely re- 
duced, that I announced to his comrades 
his approaching death, which very soon 

I should tire out the patience of my 
readers, if I were to mention all the facts 
which prove the facility with which a prog- 
nosis may be formed in this disease. 

I have observed that those attacked be- 
came almost immediately indifferent and 
insensible to their situation; so much so, 
as to refuse making use of means to obtain 
a cure. I in vain recommended to my 
friend Auriol, physician to the army, to 
employ remedies, of which he himself had 
proved the efficacy on several occasions: 
he preferred covering his head and going 
to sleep: he died in a few days. How of- 
ten have I not entreated individuals to get 
up and show me their buboes! but they 
were in so complete an apathy, that they 
preferred lying abed and sleeping, which 
was a certain symptom of their approach- 

( 34 ) 

ing death, at least unless profuse sweats 
put an end to the disease. An infirmary- 
major, of a delicate constitution and bilious 
temperament, attacked with a bubo in his 
right groin, with fever and drowsiness, 
heard, on the second night of his disease, 
several persons knocking at his door; he 
made no answer: the people believed that 
he was dead, or just dying: in this belief 
they forced the lock, entered his chamber, 
and seized on his effects, which were in a 
trunk, and even his sash, which was under 
his pillow. The disease had reduced him 
to such a state of apathy, that, although he 
perceived they were plun^ring him, he 
preferred lying in his bed and sleeping, 
rather than opposing their taking away bis 
property, He continued to sleep; but, 
fortunately for him, profuse sweats came 
on, which carried off. the disease, and put 
him in a state, on the following day, of re* 
claiming his effects, by detailing the cir* 
curastances of the preceding night. 

( 35 ) 

Of the causes which could have produced 
this disease in Egypt and Syria. 

This disease showed itself in the year 7 
(1799), at Alexandria and Damietta, in 
the months of Vendemiaire (September, 
October) and Brumaire (October, Novem- 
ber), afterwards at Rosetta, and two months 
thereafter in the army of Syria. On the 
19 Ventose (11th March), I saw, for the 
first time, under the walls of Jaffa, about 
twenty soldiers attacked with the disease, 
who, not being able to keep on their feet, 
had lain down around my tent. I had them 
carried to the field hospital,* (ambulance) 
where the majority of them ended their 

* Being entrusted with the charge of the field hospital, as 
well as the head quarters, I recollect to have amputated the 
thigh of a soldier, whose leg had been carried off close to the 
knee by a ball, with fractures of the condyles of the femur: 
on the day after the operation he was in a pretty tolerable 
state, although he was placed between two unfortunate men 
who had died the same night with buboes. This patient, after 
the storming of Jaffa, was removed to the hospital, where he 
recovered perfectly. Citizen Zink, surgeon of the second 
class, and Citizen Miot, commissary of war, who had charge 
of the head quarters, and assisted at this operation, were wit- 
nesses to this fact. 

( 36 ) 

In the supposition of contagion it is still 
a question to be answered, whether the 
disease was brought into Syria by the sol- 
diers coming from Damietta, or whether 
the Turks taken prisoners at El-Arich and 
Jaffa communicated the infection to the 
French army? 

It has never been clearly proved that the 
soldiers of Diezzar at El-Arich and at Jaffa 
were attacked with the disease. I saw, 
close to our camp, about four thousand of 
these prisoners driven together like flocks of 
sheep, and closely guarded for three days 
and three nights, without a single one fall- 
ing sick. If the disease had been amongst 
these people, it would certainly have dis- 
covered itself in some of them, which did 
not happen. This fact, known to the whole 
army, sufficiently proves, that neither the 
plague nor any other disease existed among 
the troops of the Pacha of Acre. The 
case was the same with regard to the 
Turkish troops who were in El-Arich ; since 
the Mograbins, who fought in this fort, and 
who were retained in the rear of our army, 

( 37 ) 

forming a corps of auxiliaries, enjoyed, to 
a man, perfect health. 

Let us next inquire, whether the troops 
of the division Kleber, coming from Da- 
mietta, could have brought the disease to 
the army which came direct from Cairo. 
It is a certian fact, that, after its departure 
from Damietta, the division Kleber had no: 
more sick, and, upon the arrival of the 
army of Egypt in Syria, it marched to Jaffa, 
and afterwards towards the Jordan, with- 
out having any intercourse with the troops 
which came from Cairo. 

If the army coming from Egypt, on its 
arrival in Syria, was attacked by an epi- 
demic disease, which, from the havock it 
caused, was called the plague, it ought not 
to be attributed to contagion, but to the 
fatigues we underwent in crossing the de- 
serts which separate Egypt from S'/ria. In 
order to have a just idea of this, it will be 
useful here to trace back the march of the 

The army appointed to march into Syria, 
left Cairo about the middle of the month 

( 38 ) 

Pluviose, of the year 7 (the beginning of 
February, 1799); and although then winter, 
the days were very hot, and the nights clear 
and temperate. The army, which enjoyed 
perfect health, crossed the desert with he- 
roic courage. Having, in a few days, con- 
sumed the water which we carried in our 
rear, we were often forced, by want, to 
make use of brackish water, or mud mixed 
with water, which, instead of diminishing, 
only increased our thirst. To this privation 
was added the want of live stock; and 
having no other resources, we killed the 
horses and camels, now become useless to 
us, and fed on their flesh, which we were 
obliged to eat without bread. After a 
march of one-and-twenty days, we arrived 
in Syria, and halted the 5th Ventose (24th 
February), close to Gaza; the 11th (2d 
March), nearRamla; and on the 13th (4th 
March), under the walls of Jaffa. 

The soil of Syria presented neither the 
barren plains, nor the burning sands of the 
desert which we had just crossed. At this 
period the westerly winds, loaded with va» 

( 39 ) 

pours from the sea, prevailed : these vapours > 
condensing in a colder temperature, pro- 
duced very heavy rains, accompanied with 
dreadful storms, which rendered the roads 
more fatiguing. The flats became filled 
with water, so that the waters of the rivu- 
lets, which we were often obliged to ford, 
came up to our sashes at the first step. 

How often were not our soldiers drenched 
with the rains, not only during the day, 
but also during the night! They had all 
slept on the damp soil of Ramla, had all 
breathed the thick fogs of its environs, co- 
vered with an immense number of olive- 
trees; all had not equal opportunities of 
drying their wet clothes, of covering them- 
selves during the night in order to perspire, 
nor of procuring a little brandy to warm 
themselves. Having arrived at Jaffa, the 
division Bon was encamped on the right, the 
division Lannes on the left: the head quar- 
ters of the General and the park of artil- 
lery were on an eminence to the south of 
the city: the division Bon was placed close 
to the sea, immediately on the banks of a 

( 40 ) 

lake full of stagnant water, and the direc- 
tion of the winds was such that the exha- 
lations of these marshes were carried into 
the camp of this division. The disease first 
began to show itself amongst these troops, 
although they had come direct from Cairo, 
Citizen St. Ourse, surgeon of the first class, 
made a circumstantial report to the medical 
officers in chief of the army, apprising them, 
that the division Bon, and the 32d demi- 
brigade especially, were affected with a 
suspicious disease, accompanied with bu- 
boes, from which the other divisions were 
not exempt. It is well known that the air 
of Jaffa, and of the whole coast of Syria, 
is damp, heavy, and infected by the exha- 
lations of marshes, and that the action of 
the sun's rays through this thick atmosphere 
is very pernicious. Our soldiers, after a 
residence of eight months in Egypt, were 
neither accustomed to cold nor rain, and 
could not become habituated to the great 


varieties of the temperature of Syria with 
impunity. The fine climate of Cairo, and 
the air which they there breathed, gave to 

( 41 ) 

the body a state of remarkable health, 
which of course became impaired in a damp 
and unhealthy situation. It is well known 
that an atmosphere loaded with exhala- 
tions, whether vegetable or animal, con- 
tains less of oxygen than a pure air; and 
since oxygen is the principle which furnishes 
caloric, it follows, that in a vitiated atmos- 
phere, the health must become weakened 
for want of caloric. Hence, spirituous li- 
quors, and a strengthening and aromatic 
diet, would have been very useful, because 
they excite the principle which gives life 
to the circulation of the blood and fluids 
in general. We had nothing at Jaffa but 
rice and bad bread ; animal food, wine and 
brandy were wholly wanting. 

I constantly observed that whenever the 
winds from the south and south-west pre- 
vailed, the number of sick and of deaths 
was always increased. The contrary hap- 
pened in fine weather, and when the wind 
came from the north. 

Damietta, Rosetta, and Alexandria, dur- 
ing the autumn and winter, became in the 

( 42 ) 

same state, as we shall observe hereafter, 
Alpinus has remarked, that every year very 
malignant epidemics break out in these 
cities. Autumno grassantur febres pestilen- 
tiales multce quce subdole i?ivadunt, et scepe 
medicum et cegram decipiunt. (Alpinus de 
Medicina Egyptiorum.) 

Indications of cure. 

The indications in the treatment of this 
disease were, 

1. To diminish the superabundant quan- 
tity of fluids, when such a state existed. 

2. To empty the primae vise, when they 
were loaded. 

3. To excite perspiration and sweating. 


When at the commencement of the dis- 
ease I met with persons of a good consti- 
tution, who had decided symptoms of true 
inflammation, I saw the necessity of mak- 
ing use of bleeding, in proportion to their 

( 43 ) 

strength; and I found this happen oftener 
than I should have imagined. I never had 
occasion to repeat it; but when it was indi- 
cated, this first operation succeeded very 
well: the head-ach, as well as drowsiness, 
diminished; the pulse became soft, and the 
skin relaxed, which facilitated perspiration 
and sweating. This artificial state of re- 
laxation at the same time disposed the so- 
lids the better to support the action of se- 
datives and sudorifics. When I met with 
symptoms which convinced me that the 
prima? vise were loaded, and when the pa- 
tient had been already sick, I preferred 
making him drink a glass of tepid water, 
with two ounces of olive oil, in order to 
evacuate the stomach, without irritating or 
enfeebling it by an emetic. I administered 
with advantage tartar emetic in the dose of 
two or three grains dissolved in four or six 
pints of water, as a sudorific, but never as 
an emetic or purgative, since these reme- 
dies always proved hurtful. I gave a de- 
coction of tamarinds, or of herbs, as a 
drink, to carry off the bilious stools, in those 

( 4* ) 

cases where this evacuation appeared use- 
ful. Having thus prepared the patient, I 
proceeded to calm the nervous irritation, 
and to excite perspiration and sweating; 
for which purpose I prescribed, three or 
four times a day, a little almond emulsion, 
with fifteen or twenty drops of the liquid 
laudanum of Sydenham. At the same time 
I advised the patient to keep himself tran- 
quil, and well covered, in order to hasten 
the perspiration necessary for his cure. 

While we were still under the walls of 
Jaffa, not having any other medicines, I 
made several of the soldiers take a cup of 
coffee, with the juice of a citron, instead 
of sugar, and this repeated five or six times 
a day. On our entering Jaffa, I found a 
little Peruvian bark. I then had the fol- 
lowing mixture prepared for the sick: 

Peruvian bark in powder, coffee in pow- 
der, each one drachm, boiled in eight oun- 
ces of water for a quarter of an hour, so 
as to form a strong decoction, towards the 
end adding the yellow rind of a citron. 

I gave this mixture to several patients 

( 45 ) 

dreadfully ill, every six hours, for three days 
together, and with great success. I like- 
wise found it very useful as a preservative, 
and I had a cupful given every morning to 
the wounded, to support their strength ; 
and these men often complained that they 
had not received a full cup of the bitter 
coffee, for so they called the decoction. 
From the use of this draught, and of warm 
lemonade made spirituous when we could 
find a little brandy to add to it, I have seen 
a great number of individuals attacked with 
the disease, recover; and more than two 
hundred wounded preserved, in spite of 
their constant communication with those 
who were infected. 

To diminish the head-ach of our sick,. 
many of our physxians have recommended 
the application of blisters to the nape of 
the neck, the arms, and legs. If we had 
had any cantharides, or blistering plaster, at 
Jaffa, I should have preferred applying one 
over the scalp, as is recommended in apo- 
plexies, affections of the brain, &c. having 
often seen this practice adopted by the cele* 

( *6 ) 

brated Desault, when I attended his course 
at the Hospital of Chanty, and the Hotel 
Dieu at Paris. 

It has been observed, that those people 
who manufacture or carry oil, are never 
attacked with the plague. Hence, it has 
been maintained, that frictions of tepid oil 
prevent or cure this disease. The result of 
the observations made by Father Louis of 
Padua, director of the hospital for the plague 
at Smyrna, is the most favourable. He as- 
serts, that during the twenty-seven years 
which he has been in this situation, he has 
seen no means employed against this dis- 
ease more useful than frictions of oil ; and 
to this day, in Smyrna, and several other la- 
zarettoes in the Levant, frictions of tepid oil 
are generally adopted as the best remedy. 
As soon as a patient, attacked with the 
plague, is received into the hospital at 
Smyrna, he is taken into a close chamber, 
where they light a large pan of coals, in 
which they throw sugar and juniper ber- 
ries, or other perfumes; they then strip off 
all his clothes, and rub his whole bodv with 

( 47 ) 

warm oil, until profuse sweats break out. 
The patient is then put into bed ; and when- 
ever the sweating ceases, they repeat the 
frictions in the same manner, and so on 
successively during several days, until the 
disease has spent its violence in consequence 
of the sweating. One pint of oil is suffi- 
cient for each friction, taking care not to 
commence the second before the sweating 
occasioned by the first has ceased. Those 
who rub the patient take no other precau- 
tion than that of avoiding his breath; and 
in this way none of them have ever caught 
the disease. 

In the space of five years, two hundred 
and fifty persons infected with plague have 
been received into the hospital at Smyrna, 
and I am assured that all those who were 
thus treated have recovered, and that the 
number of persons preserved from the 
plague by frictions of oil is immense. 

In whatever way oily frictions act on the 
human body, one thing is certain, that in 
the mode practised at Smyrna, they are 
useful. In my opinion, the tepid oil sof- 

( 48 ) 

tens and relaxes the skin, opens and sets 
free all the pores or extremities of the ex- 
haling vessels, whilst it produces quite a 
contrary effect on the terminations of the 
lymphatic absoi bents, which it closes up 
and obstructs. 

During the fever, the skin is commonly 
dry and shrivelled, the extremities of the 
exhaling vessels, or pores of the skin, are 
closed, and present too great a resistance 
to the more liquid part of the blood, which 
is retained in the mass of fluids. This does 
not happen when the texture of the skin is 
relaxed, and the pores open. Besides, the 
oil contributes to cleanse the skin more 
than any other fluid, and absorbs, at the 
same time, a part of the caloric accumu- 
lated on the surface of the body; hence, 
perspiration and profuse sweats follow, 
which alone cure these diseases. 

To prolong the sweating, or to excite it 
when slow in breaking out, it is necessary 
to have recourse to other means at the same 
time. Opium in substance, and all its dif- 
ferent preparations and combinations, the 

( 49 ) 

sheriaca, dioscordium, and James's powder, 
are the sudorifics most employed. Cam- 
phor, valerian, sal ammoniac, and pure am- 
monia, spirit of hartshorn, the decoction 
of the sudorific woods, of elder flowers, of 
the leaves of sage, and especially punch, 
are of great use in this disease. These not 
only excite sweating, but also give tone to 
the fibre, re-establish and strengthen all the 
bodily and mental functions, and bring back 
a healthy state of action.* 

To whatever it may have been owing, it 
is at least certain, that our medical officers 
in chief, Citizens Desgenette and Larray, 
in Syria ; Citizen Dieche, near Acre ; Citi- 
zen Savaresi, at Damietta ; Sottira, at Ro- 
setta; Ghislemi, Balbes, at Alexandria-; 
and several other physicians and surgeons* 

* The directing commissary, Michaud, being at Alexandria, 
shut up in his own house, which he dreaded quitting on ac- 
count of the mortality from the plague, which had broken out 
there, perceiving one evening that he was about to be attacked 
■with the disease, which had just carried off eleven persons in 
the same house, resolved to prepare a large bowl full of warm 
punch, the whole of which he drank off before he went to 
bed. During the night he had such violent sweats, that oft 
the morning he found himself quite drenched, as if several 
buckets full of water had been poured over his body and bed. 
The symptoms of the malady disappeared, and he recovered 
^perfectly. He is now in France. 

( 50 ) 

constantly cured two thirds of the sick 
under their care, the major part with bu- 
boes. The activity, zeal and constancy 
which these medical officers displayed under 
such circumstances, merit the highest eu- 
logium; and what trophies have they not 
earned in the numerous victims whom they 
rescued from the grave ! The cure of so 
great a number of patients of this descrip- 
tion proves how inhuman and barbarous it 
is to abandon to their fate the unfortunate, 
under the pretext that, having the plague, 
they may communicate their disease in a 
thousand fanciful ways. It follows, from 
this desertion, that they are shut up, fled 
from, proscribed, and crowded together, 
the most part of the time in infected places 
so ill suited to their cure, that they would, 
on the contrary, have contracted the dis- 
ease, if they had not had it already. There 
they no longer find the beneflcient hand to 
afford them succour, or diminish their suf- 
ferings. The overseers of the hospitals, 
whom fear and terror have rendered deaf 
to their wants, fly from them, or refuse 

( *• ) 

them those things of which they stand most 
in need; so that they are forced to end 
their days in a manner the most melancholy 
and afflicting in the eyes of him who, 
through choice, prefers and exercises the 
practice of physic. 

Of buboes and gangrenes, known under the' 
name of carbuncles, or ahthraxes. 

In my medical essay on the lymphatic 
system, I have shown the situation and im- 
mense number of glands belonging to these 
vessels. AVherever there are superficial 
lymphatic glands, there buboes may arise: 
in fact, it is not uncommon to see this dis- 
ease in different parts of the body at the 
same time. When these glands become 
inflamed, they either remain scirrhous for 
some time, or go off by resolution; but 
most frequently they suppurate. 

When the buboes are accompanied with 
a low fever, drowsiness, and loss of strength, 
the patient dies before any signs of suppu- 
ration appear in the parts. 

( 52 y 

To facilitate the suppuration of these 
glands, or buboes, some applied cataplasms 
of different kinds, but without any advant- 
age, and they always attributed the loss of 
their patient to the buboes which did not 
suppurate. Afterwards, contrary to all the 
principles of the art, they opened these 
glands with the bistoury, before they showed 
any symptom of suppuration. They soon 
perceived that this practice was not more, 
successful than the first ; and it was then 
determined to make use of actual cautery, 
from a persuasion that the fire would hasten 
the suppuration of the buboes, and put an 
end to the disease. I myself was of this 
way of thinking, and I made two cauteries 
with a hot iron, by means of which I pe- 
netrated down to the very glands : the in- 
flammation which followed produced no 
advantage. Citizens Auriol and St. Ourse, 
who employed this practice after me, not 
being more successful, gave it up. I at 
last recommended the repeated use of fric- 
tions of tepid olive oil upon the diseased 
glands, to soften the skin, and facilitate 

i * ) 

suppuration; and whenever there were cer- 
tain symptoms of a collection of matter in 
the bubo, . I opened it with a bistoury, and 
healed the sore. 

I was sent for, within a few days after 
my arrival at Jaffa, by Don JoacinaCenda:, 
grandee of Spain, father procureur, or agent, 
of the fathers of the holy land, a man very 
robust, of a full habit and sanguine tem- 
perament, aged about fifty-five. He had 
been attacked the evening before with fe- 
ver, preceded by slight shivering, accom- 
panied by such violent symptoms of inflam- 
mation, that I thought it proper to take 
away some blood. As he complained very 
much of a fixed pain in his loins, I re- 
quested to examine the part : what was 
my surprise on seeing between the last dor- 
sal and first lumbar vertebra?, a little round 
black spot, surrounded with a purple erisi- 
pelas, very extensive, and covered with 
small vesicles, or phlyctenae, filled with a 
transparent fluid. I then understood that 
the real nature of his case was a carbuncle, 
©r rather a gangrenous affection, which, in. 

( 54 ) 

three days, became seventeen inches in cir- 
cumference, and three lines in thickness at 
its edges j at its centre it had the consist- 
ence and colour of black leather. This 
patient took, in three days, five ounces of 
Peruvian bark, made use of weak lemon- 
ade for drink, and for nourishment took 
some rice boiled in a very little water, with- 
out salt, and seasoned with canella, and 
orange flour water. He also took every 
day a large cup of Spanish chocolate, and 
sometimes some Moka coffee, and recovered 
completely. I heard of him afterwards 
when in Egypt, and particularly a year af- 
ter, when at Alexandria. He had resided 
for twenty years in ancient Palestine, dur- 
ing which lapse of time he had seen the 
plague fifteen times epidemic. He had 
never contracted the disease, notwithstand- 
ing his duties as a clergyman were expos- 
ing him constantly to the contagion. 

I have seen these black spots like pete- 
chias, degenerate into true gangrenous es- 
chars, although at first they appeared, of 
very little moment. 

( 55 ] 

This disease, although local, had for its. 
cause the bad state of health of the patient j 
hence it was necessary to attack the cause 
first, in order to hasten the separation of 
the diseased from the sound parts. The 
use of bark and of opium, recommended 
by the most celebrated physicians in gan- 
grenes, antiseptics, corroborants, and sti- 
mulants, were of the greatest use, after 
having subdued the first symptoms of inflam- 
mation. The oily frictions, and the cerate 
of Galen, as simple emollients, may con- 
tribute to the spontaneous separation of the 
gangrenous part : an operation more of na- 
ture than of art. 

I have seen in Jaffa some soldiers with 
pimples or ulcers on their face, of a parti- 
cular description : although it was at Jaffa, 
I believe that this might have been the 
same as the disease called the pimple of 
Aleppo. The description which travellers 
£ive of this disease in their works autho- 
rises me to think so. (See Volney and 

I may be permitted to call in question 

( 56 ) 

the opinion that this disease arises from' the 
quality of the waters which are drank in 
this country. We observe several diseases 
indigenous in many places, without being 
able to determine their causes j and there 
appears to me as little foundation for attri- 
buting the pimple of Aleppo to the waters 
of its environs, the lepra arabum to the 
bread of Cairo, the elephantiasis to the salt 
fish of Damietta, the hydrocele to the 
brandy of dates, the ophthalmy to rice ; as 
for attributing the plague to an unknown 
vapour, brought almost every year from 
distant countries into Egypt. 

Of tlie means to be used for preventing this 

During my stay at Jaffa, I made use of 
no extraordinary means to avoid it. I was 
convinced that the disease was epidemic, 
and that, if my health became impaired 
by a concurrence of any causes whatever, 
I could not escape it, even by the most 
strict seclusion, no, not even if I had been 

( 57 ) 

surrounded by the whole guard of health 
(garde sanitaire). As I was persuaded 
that obstructed perspiration, damp and in- 
fected air, the exhalations of marshes, and 
bad food, were the principal causes of this 
disease, I endeavoured to avoid unhealthy 
places, damp and cold air, and made use 
of the best food I could procure; and as I 
knew the influence of the affections of the 
mind in predisposing to disease, I avoided 
all melancholy ideas, by being always em- 

When I went to the hospital, I always- 
endeavoured to arrive there without being 
in a perspiration; and before entering the 
wards, I took, in the apothecary's shop, a 
large cup of the bitter coffee. During my 
visit, I held in my hand a citron stuck full 
of cloves, without attributing to it any 
great importance. After paying my visit, 
I took a walk, or got on horseback; and 
although not of a constitution to perspire 
easily, I never returned without being in 
a sweat. Before going to bed, I took a 
glass of punch, or spirituous lemonade^ 

( 53 ) 

made very hot; after which I lay down, 
covering myself well up. During the night 
I never failed to perspire considerably. 
These were the only precautions which I 
took to preserve myself from the disease of 

During all the epidemic fevers, and even 
the most dreadful-plagues, there have been 
in those cities and provinces, where these 
diseases were raging, some healthy spots. 
The citadel of Cairo presents one example, 
It has been observed, that the inhabitants 
of this fort and its environs have always es- 
caped from the plague, even from that of 
the year 1791. If the inhabitants of this 
fort, in spite of their daily intercourse with 
those of the city, were preserved from this 
disease, it must be because the damp and 
infected air which had destroyed the health 
of the inhabitants of Lower Cairo, had not 
sufficient elevation to reach to the highest 
part or the citadel and its environs, and 
consequently could not impair the health 
of those who lived there. 

At the time when I. was doing duty i& 

1 59 ) 

the military hospital of this fort, I have 
often seen, at the rising and setting of the 
sun, the whole city enveloped in a mist so 
thick, that it was impossible to distinguish 
even one of the innumerable minarets of 
this immense metropolis, although the fort 
was then enlightened by the rays of the 
sun, and the air which we there breathed 
was elastic, pure, and light. 

In 1764, an epidemic fever showed itself 
in the kingdom of Naples, and, conjoined 
with famine, made such immense havock, 
that two hundred thousand persons pe- 
rished. Negligence and terror had with- 
drawn from the sick, scattered here and 
there over the city, all kind of assistance ; 
a circumstance which became the principal 
cause of the progress of this disease. Ex- 
perience having shown that the sick remov- 
ed to the sea shore recovered, a number 
of hospitals and lazarettoes were esta- 
blished there. It was observed that the 
nurses, and those employed in the hospitals, 
didmot contract the disease, in spite of the 
contagion. The principal remedies which 

( 60 -) 

were employed at this epoch were iced 
water, the bark, musk, and the vegetable 
and mineral acids in large doses. 

I can recommend nothing more useful 
and efficacious in such cases, than to re- 
move from those places where these epi- 
demics prevail, and to choose a place where 
the air is more healthy. With respect to 
soldiers, every time that a disease threatens 
to spread itself amongst them, a circum- 
stance very common in Lower Egypt dur- 
ing the unhealthy season, it is very import- 
ant to remove the camp to a healthier situ- 
ation, and to have the garrisons relieved by 
troops coming from healthy quarters, and 
then send the former to places where the 
disease has not been. There they lose the 
predisposition which they had to contract 
the disease, while the troops which shall 
have relieved the garrisons will not contract 
it so easily, because they will not have that 
predisposition ; and every time that the 
health of these new troops shall become 
impaired, they ought, without delaying oft 
any pretext, to be relieved in their turn, 

( 61 ) 

even if it should be by those who were 
there before. In order to prevent all sus- 
picion, and avoid all danger of carrying 
the disease where it has not been before, 
they should take nothing with them but 
their necessaries; they should avoid as much 
as possible halting in villages; and each 
time when they happen to encamp, they 
should expose their baggage and clothes 
to the air, which would not fail of dispers- 
ing every principle of contagion, and set- 
ting at ease the minds of those who are 
timorous. By thus changing successively 
the garrisons, we should preserve in good 
health a whole army, even in places the 
most infected. When the rains shall have 
ceased, the heats of summer returned, and 
the marshes have dried up; in a word, 
when the season shall have changed, and 
every place become equally healthy, we 
may then leave off these useful yet trouble- 
some marches and countermarches. 

Daring the expedition to Syria, the ge- 
neral of division Dugas, commandant of 
Cairo and Lower Egypt, being informed 

( 62 ) 

that the plague existed amongst the garrison 
of Fort Birketalagi, immediately stopt its 
progress, by sending the garrison to Cuba; 
there the soldiers, respiring a pure and 
wholesome air, recovered their health in a 
few days, and the troops just arrived at 
Birketalagi, preserved themselves in good 
health, the more easily, by paying a proper 
attention to cleanliness. This prudent Ge- 
neral had before observed, at Damietta, the 
advantages resulting from this measure, as 
the following letters, which he wrote to 
General Bonaparte, the 17th and 24th Ni- 
vose, 8th year (8th and 15th March, 1800),. 
bear testimony. 

" Damietta, 17 Nivose f$th March). 

" The second de mi-brigade of light in- 
fantry is affected with the prevailing ma- 
lady, more particularly than the others: this 
same regiment was also severely attacked 
a*: Menzaleh with another fever, which 
obl'ged more than two hundred men to 
^enter the hospital. A battalion of ihe - 

( 63 ) 

went to relieve them ; they have inhabited 
the same barracks, and occupied the same 
posts, during twenty-five days, and have 
not had a single sick man. Only one officer 
has had the prevailing fever, and he has 
recovered. I am convinced that this dis- 
ease takes its origin from the bitter cold- 
ness of the nights, and that it is the conse- 
quence of checked perspiration, a cause 
which, acting on several individuals at the 
same time, gives to the disease a contagious 
appearance, which vanishes on a closer 

In his letter of the 24th (15th March), 
he proposes to send to Mansoura the com- 
panies of the second demi-brigade for 
change of air, the quarters which they oc- 
cupied at Damietta being unwholesome, 
and their spirits dejected by a prepossession 
which it was necessary to do away. 

As soon as the second demi-brigade was 
on its march for Syria, forming part of the 
division Kleber, it became perfectly healthy^ 
whereas at Damietta, it had furnished five 
sixths of the sick in the hospital., 

( 64 ) 

I have also remarked, that it is even use- 
ful for the troops to march from one place 
to another, although both quarters happen 
to be equally infected. How often have I 
not seen soldiers who, on seeing their com- 
rades dying, fled from Gaza, although they 
themselves had the fever and buboes! 
These patients, at the time of their leaving 
the hospital, were scarcely able to hold 
themselves upright ; but, after having got 
some leagues into the desert, their strength 
returned, and they arrived at Jaffa in better 

After having rested themselves some days, 
I advised them to continue their route to- 
wards Acre, in order to give rise to a greater 
change in their physical and moral constitu- 
tion. It was thus that Citizen Marillac, 
officer of artillery, recovered, who was not 
able to get well in Jaffa : he was become so 
feeble, so meagre, and so much disfigured, 
that his friends could hardly recognise him. 
In this state of debility he endeavoured to 
travel to the camp at Acre. Having ar- 
rived there, he received orders to return to 

r es ) 

Jaffa, with some troops appointed to take 
charge of a convoy of ammunition, and 
pieces of artillery. In a little time he re- 
gained his good plight and former colour. 
Change of place and air, in diseases of de- 
bility, and particularly in epidemics, has 
been found useful at all times; and, I will 
even add, however severe the symptoms, 
however advanced the disease, or weak the 
patient may have been. This is so true, 
that I have actually seen men recover, who 
had not, to all appearance, two hours to 
live. Of this fact, those who assisted at 
the evacuation of the hospitals in Syria 
were witnesses. It would be impossible 
to conceive the importance, or appreciate 
the advantages resulting from this measure, 
if one had not had the means of judging of 
it by experience. Whilst the disease was 
making the greatest progress at Alexandria 
and Rosetta, the soldiers of the naval legion 
escorted, for a long while, the caravans 
which went by land. They all enjoyed 
the best health during this active service^ 
but scarcely had they become stationary at 

( 66 ) 

Rosetta, when more than two thirds fell 
sick. This fact is well known, and parti- 
cularly by General Martinet, who then 
commanded that legion. I am persuaded, 
that if those men had, instead of remain- 
ing at Rosetta, crossed the desert to go to 
Cairo, or elsewhere, they would all have 
been preserved from the disease. The Be- 
douin Arabs, wandering in the deserts, are 
never attacked, notwithstanding their com- 
munication with the infected cities, during 
the time of their most dreadful plagues. 

How many individuals, on the return of 
the army of Syria to Egypt, recovered their 
health in the desert, even at the distance 
of a few leagues from Acre, from Kaiffa, 
from Jaffa, and from Gaza! If they had 
remained a few days longer in these cities, 
they would, in all probability, have fallen 
victims to the disease.* 

* General Damas, severely wounded in the mountains of 
Mont Tabor, by a ball which had broken the humerus near its 
articulation with the fore arm, was removed to Jaffa, and 
lodged in the house of the fathers of the Holy Land. The 
accidents following upon this wound were very severe, and se- 
veral times endangered the loss not only of the arm, but the 
life of the patient. This General, during the times pf dress- 

( 67 ) 

It is a fact, that some of our sick soldiers 
in Syria, on seeing the departure of the 
army for Egypt, endeavoured to follow it 
on foot ; and although from their debility* 
they fell several times on the ground, they 
got up again, and contrived to follow the 
columns until their arrival in Egypt, where 
they recovered their health. 

Citizen Mechaud, chief of a battalion of 
engineers, communicated to me the follow- 
ing fact, which happened whilst he com- 
manded at Katie. Some soldiers, on their 
return from Gaza with a convoy, discovered 
at a distance a French soldier wandering 

ing his wound, was supported by his valet de chambre, who, 
without any bad design, kept concealed a pestilential bubo, 
which he then had, and continued in that state for two days to 
wait upon his master. There was at the same time In the 
house four persons attacked with the plague, two of whom 
died, which made General Damas determine to dismiss his ser- 
vant, and change his lodging I had him removed to the most 
elevated part of the castle of Jaffa, in order to avoid the damp 
air as much as possible. In spite of this, his wounds, which 
had before showed every appearance of healing, shortly took 
on a bad aspect, and I observed him from day to day contract- 
ing the predisposition to the disease. The fear of seeing him 
die of the plague determined me to advise him to quit Jaffa. 
From the second day of his being at sea, all the symptoms of 
the plague disappeared, and his arm healed : he can now make 
nse of it as well as formerly. He has since been nominated 
general of division, and chief of the etat major general, and 
performed the glorious campaigns of the year 8 against the 
army of the Grand Vizier. 

( 68 ) 

amongst the sands, about two leagues from 
the fort; they went up to him, and found 
him with a bundle of sorrel under his arm: 
Jhis man had been attacked with the epi- 
demic disease, and during his delirium, had 
run off from the hospital. During the fif- 
teen days which followed, he had taken no 
other nourishment but sorrel, and he reco- 
vered perfectly. I have seen this plant 
in several places in the desert, its leaves 
scarcely raised above the sand: on pulling- 
it up by the roots, it presents a weak means 
of diminishing the burning thirst of the 

Of the means zvhich might be employed inr 
Egypt to destroy the epidemic fevers. 

Before speaking of the means which 
might contribute to render Lower Egypt as 
healthy as the finest countries of Europe, 
it will not be useless to premise some to- 
pographic medical notions of Alexandria, 
Rosetta, and Damietta ; in which cities 
every year epidemic fevers break out. 

f 69 ) 

Alexandria is a city celebrated in ancient 
history, situated at 31° 13' 5" northern la- 
titude, and at 27° 35' of longitude from 
the meridian of Paris. It is washed by the 
sea on the west and the north, and on the 
east and south are situated the lakes Ma* 
reotis and Madiez. Rosetta is situated at 
28° 8' 30" of longitude from the meridian 
of Paris, and at 31° 25' 20" of northern 
latitude. It lies about two leagues from 
the sea, upon the left bank of the Nile : to 
the eastward, on the other side of the Nile, 
there are a great number of fiat grounds, 
which, after the inundation of the river, 
form very numerous and extensive marshes. 

Damietta, the third celebrated city on 
the coast of Egypt, on the eastern bank of 
the phatnitic branch of the Nile, lying in 
29° 29' 15" of longitude from the meridian 
of Paris, and 31° 25' 43" of northern lati- 
tude, has the sea and the lake Menzaleh 
to the north, and is divided by the Nile. 
The fields of rice which surround this city 
contribute to infect the air; besides, there 
are several lakes, pools, and marshes in its 

( 70 ) 

environs, which render it very unhealthy. 
Senanieh, among others, is a village remark- 
able for its insalubrity. 

The heavy rains which fall during the 
winter at Damietta, at Rosetta, and Alex- 
andria, contribute greatly to produce dis- 
eases, which the south winds, the fogs, and 
exhalations of the marshes render more dan- 
gerous. It is asserted, that these diseases 
are more frequent when the inundations of 
the Nile are high, and of long duration. 
The inundation of the year 6 (1798) was 
one of the most considerable; notwithstand- 
ing which the disease did not show itself 
but in those cities on the coast of the Me- 

The other cities of the Delta, Boulac, 
Cairo, Gizeh, and the whole of Upper 
Egypt, were preserved from it. In the fort 
of Birket-El-Agi alone, a few deaths hap- 
pened from a suspicious disease, which, in 
my opinion, without having recourse to 
contagion, were occasioned by the evapo- 
ration of the stagnant waters of the Lake 
af the Pilgrims, so called on account of the 

( 71 ) 

meeting together, at this spot, of the grand 
caravan, which every year s£ts off from Cairo 
for Mecca. The putrefaction of the aqua- 
tic plants, and of the immense quantities of 
fish in this lake, contribute to its develope- 

In the ancient histories of Egypt, there 
is no mention made of the plague. The 
former inhabitants of this celebrated coun- 
try either did not distinguish this disease 
from others, or were unacquainted with it. 

It is certain that Alexandria, Rosetta, 
and Damietta, as well as the whole surface 
of Lower Egypt, are so much changed, that 
formerly these places might have been the 
most healthy parts of Africa. The ruins 
of entire cities, destroyed and overwhelmed; 
the majestic remains of ancient monuments, 
preserved in spite of the overtlv owing ac- 
tion of time, which at this day are in part 
submerged and surrounded by water, are 
sufficient to prove the revolutions which 
this part of the globe has undergone. The 
profound and interesting researches made 
by General Andreossi, and by the respect- 

( 72 ) 

able body of philosophical men and mem- 
bers of the French Institute in Egypt, are 
worthy of examination : they are preserved 
in the Egyptian decade. 

At this day the lakes, the marshes, and 
the fjlthiness which one finds in the cities 
of Lower Egypt, are the principal causes 
of the frequent diseases to which they are 
subject, and which can never be eradicated 
until we have found means to purify the 
atmosphere of their environs. This import- 
ant advantage may be obtained by draining 
off the waters of the lakes, and filling them 
up; by keeping the cities clean, paving 
them, and giving a free exit to the rain 
water, which, stagnating in different parts 
of the cities, becomes corrupted, and, con- 
joined with filths, infects the atmosphere. 
By similar operations, several cities and 
provinces in Europe, Amer'ca, and the In- 
dies, have been rendered healthy. I have 
no doubt that the salubrity which we at this 
.day enjoy in France and Italy, is the result 
of the amelioration of agriculture, and the 
perfection of the arts. 

( 73 ) 

Of the Seclusion of the Franks during the 
time of the Plague. 

When the Franks residing in Egypt are 
assured that the plague has broken out in 
the place where they live, they retire into 
their houses, shutting all their doors, and 
having no intercourse with any one until 
the 23d of June, the eve of St. John. Not 
only are their doors closely shut, but they 
block up with care even the smallest holes, 
in order to prevent any animal entering 
their dwelling ; and if by chance a cat should 
creep in, they immediately pursue and kill 
it. For this purpose they have loaded mus- 
kets always in readiness, and springs set 
in the suspected parts of the house. The 
cats of the family are shut up in cages, like 
fowls; and if, unfortunately for them, they 
chance to leave their prison, and make their 
escape, on their return they are killed with- 
out mercy, according to the sanitary laws; 
in case they should, during their absence, 
have contracted the poison of the plague, 

( 74 ) 

and brought it home attached to their tail; 
or hair of their skin. In the lower court, 
or near to the gate of the house, they place 
three large earthen vases filled with water, 
a bason with vinegar, a furnace with coal, 
some odoriferous herbs, antipestilential 
powder and pastes, iron pincers, a large knife 
or stiletto, and some other utensils used for 
destroying the poison of the plague. Each 
family has a Turkish domestic, who is not 
comprised in the shutting up, and who is 
employed to transact all commissions: this 
man comes every morning to his master's 
house with the necessary provisions, which 
he has bought at market. The porter, who is 
generally the steadiest person in the family, 
and the most strict observer of the sanitary 
laws, after having reconnoitred the domes- 
tic, descends with the key in his hand, opens 
the door, and retires to the top of the stair- 
case, in order to avoid all risk of contagion 
from the servant, who, entering into the 
court, puts the provisions, such as meat, 
fish, herbs, and fruit, into the vases full of 
water. If he has money, he puts that into 

( 75 ) 

the vinegar; if papers of importance, such, 
as bills of exchange, invoices, &c. he puts 
these near the furnace; and after he has 
heard from a distance the porter give him 
his orders for the following day, he with- 
draws. The porter follows, and shuts the 
gate of the house: then, after having taken 
in his hand a kind of magic ring, he stirs 
about in the water the meat, the fish, and the 
herbs, in order to drown and destroy the 
pestilential poison. He then takes the mo- 
ney out of the bason of vinegar, and, hav- 
ing lighted the coals, he throws on them 
some powders and perfumes: afterwards, 
with the pincers, he takes the papers, and 
places them over the furnace, where they 
remain at least for two hours in the smoke; 
by this method, in their opinion, they are 
freed from all poison, and may then be 
touched without communicating the plague. 
They likewise purify sealed letters, and other 
papers, by piercing them with the stiletto 
in two or three places, and dipping them 
in the vinegar. The linen and other clothes 
washed out of the house may be admitted 

( 76 ) 

without any risk, provided they be still wet. 
The bread prepared in the house, and sent 
to the oven to be baked, may be received 
without any precaution, provided it has 
never been touched as long as it was hot. 
Tobacco, pulse, sugar, coffee, and every 
thing which, in the lazarettoes, is called a 
substance not contaminating (substance non 
contumace), may be admitted without pre- 
caution into the insulated houses. The con- 
taminated substances are absolutely ba- 
nished the house till the 23d of June, the 
day when all danger of the plague ceases, 
whatever may have been its violence. The 
inhabitants of the Levant have a general 
belief that the eve of St. John puts a limit 
to the plague; and at this epoch they leave 
their cloisters,embracing andcongratulating 
each other on having escaped the scourge. 

Of Lazarettoes and Quarantines. 

Lazarettoes are large buildings situated 
commonly on the sea beach, at a little dis- 
tance from the harbours, consisting of lod<*- 

( 77 ) 

ings, hospitals, magazines, and very exten- 
sive enclosures, and including a portion of 
the roadstead, or harbour, capable of con- 
taining a certain number of vessels. 

These lazarettoes are destined to receive 
and retain, for a limited time, passengers 
and ships' crews, merchandise and vessels 
coming from places where the plague is rag- 
ing, so that they may have no intercourse 
with any one whatever, till the termination 
of the quarantine. 

Quarantines are divided into quarantines 
of rigour, and those of observation. Qua- 
rantines of observation never exceed fifteen 
days, and are never less than five: quaran- 
tines of rigour consist of thirty-nine days, 
or forty, computing from the day of com- 

Such vessels as come either from the coast 
of Africa, in the Mediterranean, or from 
any sea-port town in the Levant, are put 
under quarantine ; that is to say, they sail 
into that part of the roadstead, or harbour, 
which is appropriated to the lazaretto ; after 
which the captain of the vessel presents 

( 78 ) 

to the board of health (bureau sanitaire) 
his certificate of health, in which are spe- 
cified his destination, the day of his depar- 
ture, the names of himself and his vessel, 
the cargo, the number of his crew and 
passengers, and whether, in the place from 
whence he came, there were any instances 
of the plague. This certificate is taken 
through a grating by means of a pair of 
long pincers, and is not read until it has been 
thoroughly perfumed and dipped in vinegar. 
If the certificate gives notice of the plague, 
the vessel is considered foul (brute) ; if on 
the contrary, it states that, for some time 
past, there has not been an instance of the 
plague in the place from whence she sailed, 
she is considered clean (nette) ; if it was 
only a short time since the plague had 
ceased, she is considered suspected (sus- 
pectej. In the first case, the passengers and 
ship's crew are strictly reviewed at a dis- 
tance; and although every one of them 
should enjoy perfect health, they are all 
placed under a quarantine of rigour. When 
the certificate is clean, the quarantine lasts 

( 79 ) 

a shorter time; and in the third and last 
case, it is a quarantine of observation, which 
lasts a longer or shorter time, according to 
the decision of the conservators of health. 

If any vessel, before entering the harbour, 
has been visited by a vessel from the coast 
of Africa, or from a sea-port in the Levant, 
or belonging to an enemy, she is placed 
under strict quarantine, even if she had come 
from the nearest port ; as, according to the 
sanitary laws, her certificate is considered 
foul f brute J. 

When merchandise is put under quaran- 
tine, it is deposited within the enclosure, 
or in the magazines appopriated for that 
purpose. The establishment for this end, 
at Marseilles, is very beautiful, of prodi- 
gious extent, and shows the importance of 
the commerce which France carries on with 
the Levant. The passengers are put on 
shore, and sent into the enclosure with one 
or more guards of the committee of health 
fcomile sanitairej, while the ship's crew re 
main on board, with some others. The por- 
ters, and those persons employed to purify 

( 80 ) 

the merchandise, in order to ascertain whe- 
ther or not the bales of wool and cotton con- 
tain the vapour of the plague, open them in 
the middle, and thrust in their bare arms, 
believing that, if they contained the plague, 
the disease would without fail show itself 
on them. They break open the chests and 
trunks, and expose to the air the bales of 
flax and of silk, the cloths, sails, stuffs, and, 
in short, every article on board. They pre- 
tend in this way to facilitate the evapora- 
tion of the pestilential fomes, which per- 
chance might have been brought in along 
with the merchandise. At length, after 
having exposed every thing day and night 
to the air for the space of thirty-nine days 
(serine) j after having, in the course of the 
quarantine, perfumed the passengers, the 
ship's crew, and the vessel, three times, 
they permit them to enter the harbour. 

If, during the time of the quarantine, any 
one falls sick and dies, should the cause of 
his death be suspected, the quarantine is 
prolonged, and sometimes it recommences, 
and thisevery time such an accident happens 

( 81 ) 

When the death of several persons on 
board puts out of doubt the existence of the 
plague, and that it is making progress in- 
stead of diminishing, the laws of health 
condemn the vessel, without any reserve, 
to the flames. Those who compose the 
crew, after being stripped of all their clothes, 
and having their whole bodies shaved and 
washed in sea-water, are admitted into the 
lazaretto, in order to undergo there a rigor- 
ous quarantine. The vessel, with its mer- 
chandise, is towed out to sea, where it is 
either sunk or committed to the flames. If 
the porters employed to purify the merchan- 
dise are attacked with the plague during 
the quarantine, or some days after that ope- 
ration, the committee of health pronounce 
the goods infected, and, without delay, 
cause them to be burnt or sunk. 

It has often been said, that in breaking 
open a letter, or in opening a bale of cotton 
containing the germ of the plague, men 
have been struck down and killed by the 
pestilential vapour. I have never been able 
to meet with a single eye-witness of this 

( 82 ) 

fact, notwithstanding the inquiries which I 

have made in the lazarettoes of Marseilles, 

of Toulon, of Genoa, Spezia, Leghorn, 

Malta, and in the Levant. All agree in 

repeating, that they have heard of such an 

occurrence, but that they have never seen 

it happen. Among those whom I have 

interrogated about this fact, I may name 

Citizen Martin, captain of the lazaretto of 

Marseilles, who, for thirty years past, has 

held that situation: this brave and rsspect- 

able man told me, that during that time he 

had seen opened and emptied some millions 

of bales of cotton, silk, furs, feathers, and 

other goods, coming from several places 

where the plague raged, without having 

ever seen a single accident of the kind. 

Observation, necessity, and experience 
have taught that all substances which are 
necessary to life, are not equally susceptible 
of imbibing the pestilential poison; that 
there are even some which are not suscep- 
tible of contracting it, and which conse- 
quently cannot communicate the plague. 
The substances liable to communicate 

( 83 ) 

the plague are called contaminating, while 
those which cannot imbibe this poison, are 
called non-contaminating. 

I think we may distinguish three classes 
of contaminating substances. For example, 
wool, cotton, silk, hemp, stuffs, hides, all 
kinds of hairy skins and furs, are contami- 
nating substances of the first class. These 
substances do not lose their infectious qua- 
lities until after forty days exposure to the 
air (serhie). 

There are goods which, in order to pu- 
rify from the poison of the plague, it is suf- 
ficient to put in vinegar, or in perfumes : 
such are papers, as well as samples of stuffs, 
&c. which I rank in the second class. 

Gold, silver, and all the other metals, 
porcelain, delft-ware, and glass, although 
they are non-contaminating substances, may 
contain some foreign body, charged with 
pestilential poison, if they have been hand- 
led by infected persons ; and they ought to 
be put in water, as well as fresh fish, meat, 
herbs, fruits, and all kinds of animals hav- 
ing hairy skins. I consider these substances 

( 84 ) 

as contaminating of the third class ; fresh, 
or sea-water being perfectly sufficient to de- 
stroy any of their contagious properties. 

Wax-cloth and stuffs, when they are wet, 
do not communicate the plague. Every 
kind of wood, straw, hay, flowers, osiers, 
mats, provided no hempen nor cotton 
threads enter into their texture, wax lights 
and candles, provided the wick be burnt 
to the level of the wax or tallow, ivory, 
mother of pearl, wheat, seeds, tobacco, 
coffee, sugar, pepper, and aromatics, salt, 
oil, and liquors, are not liable to imbide 
nor to communicate the plague. 

These principles being established, the 
officers of health prolong, abridge, or mo- 
dify the quarantine, delivering or detaining 
for a longer or shorter time the persons and 
goods in the lazarettoes. 

It follows from these principles, acknow- 
ledged by the officers of health, that you 
may inhabit the same house, the same ves- 
sel, the same chamber, walk together, sleep 
upon the same beds, or the same mats, 
and keep company with persons under qua- 

( 35 ) 

rantine, even whilst they are attacked with 
the plague, provided you do not touch 
them neither directly nor indirectly. You 
may take snuff offered by a person having 
the plague, provided the box be of wood 
or of shell. There is no danger even in 
breaking bread with them, provided the 
bread be cold; for if it were warm, it might 
communicate the plague. How then is the 
reason of all this to be explained ? Those 
who wish to have the fullest details upon 
lazarettoes, quarantines, the manner of pu- 
rifying contaminating substances, and to 
acquire the fullest ideas on the subject of 
the plague, should consult the codes of 
health at Marseilles, at Toulon, and at Ve- 
nice. They will also find, in a work of 
J. P. Papon, ci-devant historiographer of 
Provence, printed at Paris in 1800, the 
memorable epochs of the plague, from 
1491 before the birth of Christ, till that of 
Marseilles in 1721 of the Christian sera. 
They will there learn the means which are 
proposed for preventing this disease, upon 
the frontiers of a country which it is ravage 

( 86 ) 

ing, as well as the precautions to be adopted 
in cities having the plague. There is also 
a good deal said of the purification of goods, 
of houses, of preservatives, of lazarettoes, 
of the police of sea-ports, &c. Had I not 
predetermined to state nothing but the ob- 
servations made by myself in Egypt and 
Syria, I should have added a few reflections 
on the work of this author. I, however, 
reserve them till a future occasion, when I 
mean to analvse this disease more at length. 
On an unprejudiced examination of the 
works of writers on the plague/ we find 
nothing but frightful recitals of what hap- 
pened in the epidemics which they have 
described. They a.11 insist on the necessity 
of quarantines, and forbid the inhabitants, 
under pain of death, to quit their houses, 
whenever there has happened any death 
by the plague ; believing that this means will 
suffice in stopping its progress. It is not 
difficult to conceive that the shutting up 
together of several people in good health, 
and some sick, and obliging them to breathe 
the same air, which everyday becomes more 

( 37 ) 

and more infected, must augment the dis- 
ease of those who are already sick, and ex- 
pose the others to contract it. Experience 
has proved that these seclusions, or shuttings 
up frenfermemensj, have never succeeded 
in arresting the progress of the plague, 
This disease always commences by attack- 
ing the poor in the most unwholesome 
quarters of the city; after which the health 
of the inhabitants in good circumstances be- 
comes impaired, and at length death levels 
indiscriminately the poor and the rich , Then, 
all becomes confusion in the city: the magis- 
trates are no longer able to maintain their 
authority, the shuttings up cease by little and 
little, the season changes, the atmosphere 
becomes purified, those who have escaped 
recover strength and courage, and all at 
once the epidemic ceases. This is what 
has been observed in all plagues, but par- 
ticularly in that of Marseilles, in 1721. 
The history of these epidemics strikes one 
with horror; and, after comparing them 
with the most malignant plagues of the Le- 
vant, where the shuttings up are only in use 
amongst a very small number of individuals, 

( 88 ) 

I have no hesitation in declaring, that in 
Europe the mortality has been the greatest. 
It is generally thought that the principles 
of fatalism of the Turks contribute greatly 
to increase the propagation of this disease 
amongst them, because they will not make 
use of any precautions. This much how- 
ever is certain, that the Mussulmen, during 
the plague, attend on their sick with parti- 
cular care even to the last moment of their 
lives ; whilst, on the contrary, our sick are 
separated from the rest of the family, and 
abandoned to their unfortunate lot, the 
mother even refusing to carry assistance to 
her own son during the agonies of death, 
and the husband not daring to approach 
the dearest object of his affections, who re- 
quests from him a drop of water in a voice 
the most tender and supplicating. A like 
inhumanity has place neither in Asia nor 
in Africa ; and if I were doomed to be at- 
tacked by the plague, I should by far pre- 
fer being in the hands of the Turks, than 
in those of the Europeans. 

Si quid novisti rectius istis, 
Candidas imperti ; si non his mere mecunv 

( 89 ) 




Observed in the Ligurian Republic, and in, 
the Hospitals of the Army of Italy, in the 
Year 8 (1799-1800). 

1 HE analogy and affinity which all epi- 
demic fevers bear to each other ; the facility 
with which an alarm is propagated as soon 
as one of these dreadful diseases discovers 
itself in any city or province, has induced 
me to state here my opinions upon a pecu- 
liar epidemic fever, which alarmed the in- 
habitants of the environs of Montpellier, 
during the first months of the year 8 (1799- 
1800). See the Journal de Medecin, page 

An epidemic disease spread its ravages 
in the hospitals of the army of Italy, and 
carried off daily its numerous victims. Fly- 
ing report, which always magnifies every 

( 90 ) 

danger, and attenuates every good, spoke 
of nothing but the number of deaths : al- 
ready even the name of the pestilential dis- 
ease spread dismay far and wide. In this 
alarming situation, the public authority 
thought proper to consult the school of me- 
dicine of Montpellier, which hastened to 
calm their inquietude, and reanimate their 
spirits, by proving that this fever, falsely 
regarded as pestilential, was not at all dif- 
ferent from the fever of hospitals, the typhus 
carcewitnot Pi ingle, or the fever of camps and 
armies, jebris castrensis : and, as a mode of 
preservation, they recommended a generous 
strengthening regimen, great cleanliness, 
pure and frequently renovated air, and a 
state of mind exempt from fear and inquie- 

On my return from Egypt to France, I 
arrived in the gulf of Jouan the 25th Prai- 
rial of the year 8 (14th June, 1300), and I 
collected the particulars of the epidemic 
which had just carried off a great number 
of the inhabitants, and of the soldiers in the 
environs. It was the same as that which 

( 91 } 

we have just been describing ; and it was 
observed during this epidemic, that the in- 
habitants residing near the sea were more 
exposed than those who were at some dis- 
tance ; and that there were several villages 
situated on the heights, which had not even 
a single sick person. 

With regard to this disease, the majority 
attributed it to the rains and the fogs. A 
citizen of the environs of Antibes assured 
me, that if this disease had taken place 
some months before, it would, without fail, 
have been attributed to the vessels just ar- 
rived from Egypt, and which had put ashore 
at Frejus without performing quarantine. 
A similar epidemic, probably the same, 
showed itself in the hospitals of Genoa some 
months after ; and it was stated in the pub- 
lic papers, that a physician of that city had 
refused to go and take charge of the sick 
of the hospital, for fear of the contagion. I 
am led to think that this citizen was read- 
ing at the time the work of M. Papon, in 
which are related the particulars of the 
plague of Marseilles. If I were to give 

( 9* ) 

advice to medical officers employed in treat- 
ing epidemic diseases, it would be to banish 
melancholy and fear, to live well, and avoid 
all excess; and if they are fond of reading, 
to choose amusing books in preference to- 
those which treat of the plague . 

( 93 ) 



In the Year 1 800, 

IN treating of the disease of Egypt, known 
by the name of the plague, and of the epi- 
demic fever, observed during the year 8 
(1800), in the bay of Genoa, at Nice, and 
at Montpellier, we have seen with what 
facility we are deceived with regard to the 
nature and causes of these diseases. When 
a dreadful epidemic breaks out in any city 
or province, we, without fail, have recourse 
to some peculiar poison, imported from dis- 
tant countries. Hence, some have made 
the yellow fever come from Palestine, and 
others from the West-Indies. 

Amongst the authors who have written 
on this disease, some say that it spreads it- 
self by contagion ; others, that this happens 

( 94 ) 

but rarely. (See Hillary's Description of 
the Yellow Fever which prevailed at Bar- 
badoes.) There are even some physicians 
who maintain that it is no wise contagious. 
In the Journal de Medecin, of Paris, in the 
year 9 (1801), Citizen Halle, professor of 
the school of medicine, has given us the 
history of the yellow fever of Cadiz. As we 
have been treating of an epidemic which 
may have some affinity with other diseases 
of this nature, I may just be permitted to 
mention here its principal features, and to 
add some reflections and queries, which 
may perhaps tend to procure us some more 
distinct ideas of this disease. 


From the 10th to the 15th of August, in 
the year 1800, there broke out in the quar- 
ter of St. Mary, at Cadiz, a fever, which, in 
the end, ravaged this city in a short time: 
it had the character of a slow nervous fe- 
ver. In the supplement of the Gazette of 
Madrid, we read, that some corsairs and 

( 95 ) 

sailors, consisting both of strangers and na- 
tives, brought this disease into a single fa- 
mily in this populous part of the town, and 
that from thence it communicated itself 
to all those who had any intercourse with 
them, and afterwards spread itself to all the 
other quarters, attacking indiscriminately 
all classes of the inhabitants of this city. 


With regard to the cause of this disease, 
the author of the Journal de Medecin thinks 
that it certainly was not caused by the im- 
portation of any contagion. He thinks, 
with reason, that fear and terror, and the 
long-continued heats of a burning summer, 
preceded by heavy rains, and followed by 
a very warm easterly wind, which lasted 
forty days, and which made the thermome- 
ter of Fahrenheit mount to 85 degrees, 
might, in the end, have facilitated and ren- 
dered more rapid the course of this disease, 
.called the yellow fever on account of the 
yellowness which supervened. It began 

( 96 ) 

by shiverings, accompanied by general un- 
easiness, and a bilious vomiting of a yellow 
or green colour, stools of the same nature, 
loss of strength, quick pulse, burning skin, 
heavy pains in the head, temples and or- 
bits, pains in the loins, the bones, and su- 
perior orifice of the stomach. If these 
symptoms continued increasing until the 
fourth or fifth day, the patient was in jeo- 
pardy : the yellowness supervened, accom- 
panied by subsultus tendinum, petechia?, 
and hiccough ; the vomitings and stools be- 
came bloody, blackish, and foetid ; the ex- 
tremities cold; and all the symptoms of 
putridity appeared. If, on the contrary, the 
sick felt some relief on the first days of the 
disease, there was then reason to look for 
their recovery: the yellowness, haemorrha- 
ges from the nose or the fundament, were 
not bad symptoms, provided vomiting or 
hiccough did not supervene. Some pati- 
ents were observed to have phlyctenae, and 
swellings of the parotids ; and others had 
phlegmonous tumours, which were termi- 
nated by gangrene. 

( 91 ) 

The dissections of several dead bodies 
showed bilious collections in the liver, the 
gall bladder distended, the gall ducts ob- 
structed, and in general an erysipelatous 
inflammation of the abdominal viscera, and 
very frequently gangrene of the intestines 
and stomach, 

Method of cure. 

Several patients, who were slightly at- 
tacked, were cured by a little of the acn 
dulous tartrite of pot-ash, some decoction 
of bark, slight sudorifics, lemonade, and 
nitrous drinks, not omitting glysters, and 
some gentle laxatives. In the more severe 
attacks, vomits on the first day of the dis- 
ease were employed ;* the second day bark 
was administered, in order to prevent the 
exacerbation on the third ; whey, with a 
little syrup of borax, or nitrous sether, was 

* Citizen Halle has with reason remarked, that almost all! 
those who have seen the yellow fever in the West-Indies, have 
dreaded emetics, as augmenting the irritation in the stomach, 
exciting vomitings which could not be stopt, and hastening the 
gangrene of this viscus. (See Roupp, Bruce, Lind, Hil- 
lary, &x.) 


( 9* ) 

added to the tisans, and advantage was de- 
rived from glysters of decoction of tama- 
rinds, or decoction of bark. In order to 
moderate the vomiting, and calm the hic- 
cough, they gave camphor emulsion in large 
doses: emulsion, with lemon juice in par- 
ticular, was most successful in stopping the 
hiccough. In the haemorrhages they made 
use of the sulphuric acid, sufficiently diluted, 
but in repeated doses. Blisters produced 
the best effects during the comatose state.* 
In those cases where, with the yellow- 
ness, a bilious diarrhoea came on, they ad- 
ministered a laxative tisan made from ta- 
marinds. If the evacuations were accom- 
panied with fainting fits, they gave the pa- 
iient a few spoonfuls of a cordial mixture, 
with some vitriolic aether mixed with water 
of linden tree flowers; the burning heat in 
the intestines was moderated by emollient, 
oily, and anodyne glysters. In the worst 
cases they employed the decoction of bark 

* Hillary says, that blisters, so far from being useful, aug- 
mented the comatose affection, the trembling, subsultus tend!- 
lium, coldness of the extremities, and haemorrhage. 

( £&; ) 

with vitriolic aether, opium, the liquor anc- 
dynus, &c. Sometimes a violent fever 
showed itself, followed by fits of intermis- 
sion ; and although the bark prevented the 
attack on the following day, the patient 
was destroyed in a very short time. This 
circumstance recals to my mind a case nearly 
of the same kind, which occurred to me 
whilst I was physician and surgeon in chief 
of the Duke of Modena's body guards. 
M. Volpi, a young man belonging to the 
corps, of a very robust habit, not being 
able to void his water, endeavoured to in- 
troduce into the urethra some thick violin 
string, which irritated the prostate and pas- 
sage to such a degree, that a considerable 
swelling of the yard followed, accompa- 
nied with inflammation. The case was so 
severe, that I called in consultation one of 
the physicians of the city, who considered 
the patient to be attacked with an intermit- 
tent fever, and persuaded him to take bark 
in large doses, in order to stop the double 
tertian, which was merely symptomatic, 
arising from the inflammation of the uri- 

{ 100 ) 

nary passages, and followed exactly the 
course of a true fever of suppuration. The 
physician gave himself credit on seeing the 
patient free from fever, but the gangrene 
made such a rapid progress that death fol- 
lowed when we believed him out of dan- 
ger. It is clearly to be perceived, that bark 
was not the most appropriate remedy in 
such a case, and that its tonic action only 
augmented the disorder, particularly as it 
was administered at a period of the disease 
when the irritation and state of the patient 
required emollients and refrigerants. 

It appears evident to me, that the yeilow 
fever of Cadiz, in spite of its resemblance 
to the slow nervous fever, had at times the 
inflammatory character; and it is not sur- 
prising that the bark then hastened the gan- 
grene, by augmenting the inflammation. 

Means of prevention. 

At the breaking out of the disease at Ca- 
diz, the common sewers were ordered to be 
cleansed, and the dead bodies buried with- 

( ioi ) 

out the city. An hospital also was provided 
for the soldiers and sailors, at some distance. 
These means could not fail of being very 
proper, and much more useful than water- 
ing the doors of the houses, than the smoke 
of the branches of green pine burnt in the 
public squares and streets, the fumigating 
and sprinkling the houses with aromatic 
vinegar, and the firing off of gun-powder in 
different quarters ; means truly of small avail 
in purifying the atmosphere of a city such 
as Cadiz. 

Queries respecting the Yellow Fever which 
appeared at Cadiz in the year 1 800. 

1. Is it quite certain that this disease was 
the yellow fever? 

2. Is it sufficiently proved that it was 

3. Is it a certain fact that the corsairs and 
sailors brought this disease into Cadiz? 

4. What are the circumstantial details 
which prove these assertions ?- 

5. The heavy rains of the spring 3 the ex- 


( 102 ) 

eessive heats of the summer, the hot and 
constant easterly winds, the hardships which 
the inhabitants had experienced, and were 
still suffering — were these not sufficient cau- 
ses to give rise to a disease dreadfully epi- 
demic, contagious, and mortal? 

6. What were the means employed for 
arresting its progress? 

7. How were the means of curing and 
destroying it discovered? 

8. If it was contagious, how came its 
progress to be stopt amongst that class of 
people who possessed neither the means nor 
the possibility of avoiding the contagion? 

9. If it was evidently contagious, how 
came it not to be communicated at other 
times, when there were received into Cadiz 
without precaution, persons recently con- 
valescent, and perhaps attacked with the 
yellow fever, coming from Carolina and 
Philadelphia? If a predisposition be requi- 
site to produce it, the disease then cannot 
be eminently contagious. 

10. The influences of seasons, times and 
situations, are equally fatal to all, and not 

( 103 ) 

more so to the poor than to the rich. The 
effects of contagion, on the contrary, may- 
be prevented by persons possessing the 
means of preserving themselves from it. 
As to the poor, it is impossible for them to 
avoid it, particularly if they have any sick 
amongst them. 

11. Was the number of deaths known? 

12. Was it as considerable as is re- 

Ssepc fama crescit eun.jk?. 

( 104 ) 

1 HE dysenteric flux attacked a great 
number of our soldiers in Egypt, at the be- 
ginning of autumn, in the year 6 (1798), that 
is to say, when the coolness of this season 
began to moderate the excessive heats* of 

Obstructed perspiration was the chief 
cause of this disease. It is well known that 
when the pores of the skin are closed up, 
the fluids are -carried to the intestines, and 
give rise to diarrhoea, Cutis striata, alvus 
laxa est. 

Sanctorius has proved to us, that of the 
eight pounds of nourishment which a man 
takes during the twenty-four hours, he loses 
five by perspiration. If this perspiration 
happens to be stopped by any cause what- 
ever, derangements in the animal functions 
must necessarily follow. Experience has 
shown us that it is to the intestines the fluids 
are carried, and produce diarrhoea. 

( 105 ) 

This disease showed itself on the majority 
of our soldiers a very short time after their 
arrival in Egypt. We have said, in the In- 
troduction, that the nights were cold and 
damp, and that the men took no precaution 
to guard against their bad effects. Hence, 
amongst other inconveniences which neces- 
sarily followed, our troops were first at- 
tacked with diarrhoea. The pastiques, or 
water-melons, the milk, and the water of 
the Nile, which our soldiers drank in too 
great a quantity, contributed to keep up 
this excessive evacuation. In several indi- 
viduals, the diarrhoea degenerated into the 
white dysentery; and it was not unusual to 
hear the patient say, " My stomach does 
not now digest my food, for it passes in the 
same state as when I take it," They did 
not suffer any cholic pains, and very few 
made use of any remedies for its cure. The 
frequency of the stools did not fail to irritate 
and heat the extremity of the rectum. This 
excoriation was nothing but the effect of the 
quantity, and not the quality of the stools, 
as the slight inflammation which attacks the 

( 106 } 

nostrils in coryza is owing to the quantity 
of lymph which flows over the parts, and 
not to its acrimonious quality, as some 

Besides the fluids of perspiration, which 
are carried to the intestines, the bile flows 
in a greater quantity into this canal, the 
stomach loses its strength, and the gastric 
juice becomes less powerful, or when scarce- 
ly secreted, flows into the intestinal tube, 
on account of the over-increase of the pe* 
ristaltic motion. This derangement of the 
stomach must of course produce bad diges- 
tion ; and the half-digested food must give 
rise to the disengagement of a quantity of 
air. It is to this particular gas that I attri- 
bute the first cholic pains which the sick 
experience. In this period of the disorder 
there supervenes, in my opinion, on the 
irritated parts, some slight inflammations 
upon different spots in the intestines, and 
segments of the internal coat are in some 
points detached, whence there follows the 
mucous or glary dejections, which many 
persons call the grease of the intestines, 

"( 107 ) 

When the diarrhoea has arrived at this 
second stage, it is then become dangerous, 
and requires to be treated in the manner 
we shall now point out. 

If we neglect to use the means proper for 
checking the progress of this disease, it very 
soon becomes a true bilious fever, accom- 
panied with very frequent stools, requiring 
very considerable efforts to void a quantity 
of glary and often bloody matter. Several 
of the sick in this state, weary of following 
the advice of physicians, tried to arrest the 
course of their disorder by eating hard boil- 
ed eggs, sprouting beans, and other reme- 
dies, considered as specific A great weight 
at the stomach, burning thirst, bilious vomit- 
ings, stools of a blackish colour, putrid, and 
of an insufferable stench, were soon the 
consequence of this bad practice. But still, 
hoping to be cured in twenty-four hours, 
they preferred going on taking a load of 
medicines, directly contrary to each other, 
which were given them by quacks; and in 
this manner completely dissipated the little 
strength they had left. 

( 108 ") 

After this statement, it is easy to be per- 
ceived that I distinguish three stages in the 
dysentery of Egypt. The first stage is the 
simple flux, or diarrhoea j the second is 
when it is accompanied by cholic pains, and 
mucous evacuations; and the third, when 
fever shows itself, and the evacuations be- 
come bilious, putrid, and bloody. 

Treatment, and means of preventing this 

The indications which present themselves 
in the treatment of the dysentery, vary ac- 
cording to the different stages of the dis- 
ease. In general, in the simple flux it is 
necessary to facilitate the evacuation of the 
putrid or vitiated matter contained in the 
stomach and intestines ; to diminish the 
great sensibility of these parts, and to re- 
establish the obstructed perspiration. In 
order to facilitate the evacuation of the pu- 
trid and vitiated matter in the stomach and 
intestines, I constantly prescribed an emetic 
in the morning. I preferred ipecacuanha to 

( 109 ) 

the tartarised antimony ; and in the even* 
ing I gave the sick an anodyne draught, 
with twenty drops of the liquid laudanum 
of Sydenham : I recommended to them at 
the same time to keep themselves well co- 
vered, and I afterwards made them take 
some boluses of diascordium, the white de- 
coction for ordinary drink, some rice and 
sheep's trotters for food. The oranges and 
pomegranates, fruits in great abundance in 
this country during the season when this dis- 
order prevails, were very useful in quench- 
ing the thirst and refreshing the mouth, 
without relaxing the stomach and intestines, 
as watery drinks are apt to do. Afterwards, 
the conserve of orange peel, preserved with 
sugar and not honey, coffee, and a little Cy- 
prus wine, contributed greatly to strengthen 
the functions of the stomach. 

When the evacuations had recovered 
their proper consistence, the patient was 
considered as cured : but if a too great con- 
stipation followed, glysters were preferable 
to purgatives, since the slightest laxatives 
exposed the patient to a relapse. When the 

( no ) 

flux was accompanied with colic pains, 
and the patient's stools were mucous and 
glary, I had recourse to injections of de- 
coction of lintseed, poppy heads, of milk, 
of broth made from tripe and sheep's trot- 
ters, &c. &c. For a long time, and under 
different circumstances, I made use of a 
number of remedies, cried up in that 
country as specifics in the cure of the dy- 
senteric flux j but I have never been able 
to collect a sufficient number of facts to 
convince myself of their good effects. 

I am persuaded, that in order to treat 
this disease in the second and third stages, 
we must pay attention to the constitution 
and strength of the patients, in order not 
to irritate too much with tonics and as- 
tringents on the one hand, nor to relax 
them by laxatives and refrigerants on the 
other. I have seen individuals, to whom 
bleeding was of great utility : I have also 
seen others, to whom it proved quite the 
contrary. Opiates have, in the course of 
twenty-four hours, cured some who had 
^een long ill, without any inconvenience 

( 111 ) 

accruing afterwards; but I have seen the 
same class of remedies augment consider- 
ably the fever and colic pains in persons 
of a meagre, delicate, and bilious habit. 
In this case lemonade, with the acidulous 
tartrite of pot-ash, or the tisan made from 
tamarinds for drink, rice for food, and glys- 
ters of milk, produced the best effects. I 
am, however, persuaded, that the food of 
which the sick made choice, and the ex- 
cesses which they committed, were fre- 
quently the chief causes which prevented 
their recovery. 

When the dysentery, accompanied with? 
fever, has arrived at its third stage, the 
fever ought to be treated as putrid, and 
the, bilious evacuations accompanying it 
should not be stopt ; but as soon as we can 
flatter ourselves with having evacuated all 
the bile and other corrupted matter, by a 
moderate use of gentle laxatives, sometimes 
giving a weak decoction of rhubarb, at 
another small doses of ipecacuanha, we 
ought then to have recourse to anodynes 
and opiates. 

[ H2 ) 

Citizens Desgenettes and Larray, chief 
officers on the medical staff of the army of 
the East, and all my colleagues, have ac- 
knowledged, in the treatment of this dis- 
ease, the sovereign powers of opium, which, 
administered at a proper period, produces 
constantly the best effects. 

I have not had occasion to make use of 
blisters, as I do not believe them to be of 
much utility. In order to quiet the pains 
in the abdomen, I have always preferred, 
in every kind of colic, to have recourse 
to anodyne fomentations and tepid baths, 
when the strength of the patient admitted 
of it, according to the practice of Pringle, 
Lind, and other celebrated authors. These 
great practitioners, in order to dispel the 
pains, likewise made use of a blistering 
plaster applied over the abdomen j and 
Citizen Barbes, physician in ordinary to the 
army of Egypt, used to apply large blisters 
over the abdomen of several patients at- 
tacked with dysentery, of whose safety he 
despaired, and in a few days they recovered 
(See the Egyptian Decade.) 

( us ) 

Several persons stopt the dysenteric flux 
by giving small draughts of decoction of 
die peel of pomegranate, three times a day, 
or still oftener. In Upper Egypt they make 
use of quinces seasoned with pepper, to 
stop the diarrhoea and dysentery. In Italy 
they boil this same fruit in a small quantity 
of water till it becomes reduced to a jelly, 
which they give with advantage by spoon- 
fuls to the sick. In France it is given in 
the form of a conserve. 

Amongst the remedies which the physi- 
cians of Cairo recommend for curing the 
dysentery, is a fruit, from Sennaar, called 
hao-bab, or the monkey's bread, The rind 
of this fruit powdered and taken in small 
doses, frequently repeated, as well as the 
substance adhering to the seeds, which has 
a sourish-sweet agreeable taste, is extolled 
as a specific in the dysentery of Egypt. I 
myself made use of it at Cairo in several 
cases with advantage ; and I found in the 
sweet powder of the hao-bab, an antiseptic 
as well as an astringent. quality. 

The means to be employed for preserv- 

( 114 ) 

ing oneself from the dysenteric flux, con- 
sists in avoiding the suppression of perspi- 
ration, by sleeping in a well-closed apart- 
ment, and by covering oneself thoroughly 
when forced to pass the night in the open 
air. It is very useful in Egypt, in order to 
prevent too great a relaxation of the fibres 
of the stomach, to mix with the Nile wa- 
ter, which serves for ordinary drink, a little 
brandy, in preference to vinegar. This pre- 
caution becomes the more necessary, if 
much use be made of lemonade. The want 
of wine is of great consequence to those who 
are habituated to that liquor. In Egypt 
they who substituted brandy and coffee in 
place of wine, enjoyed good health : those, 
on the contrary, who drank nothing but the 
Nile water in great quantities, and took a 
good deal of milk, greens, and watery fruits ; 
who, in the evening and night, to enjoy the 
cool air, undressed themselves, or slept upon 
the damp ground, were attacked with dy- 
sentery ; and when these individuals perse- 
vered in following this regimen, they were 
soon under the necessity of applying for 

( m ) 

medical assistance. Doctors Bruant, Bar- 
bes, Savaresi, and Renati, physicians in or- 
dinary to the arhiy of the East, paid par- 
ticular attention to this disease. (See their 
Memoirs in the Egyptian Decade. J 

( 116 ) 



A HE ophthalmy of Egypt is a true de- 
fluxion of humours which deposits itself 
either upon one eye only, or upon both at 
the same time. This disease is endemial, 
sporadic, and epidemic; and takes place 
principally on the approach of autumn. 
Autumno lippiludines <Sf oculorum jiuxiones 
Jktnt. (Hippocrates.) 

The ophthalmy of Egypt showed itself 
among the soldiers of the army of the East 
at the commencement of the year 6 (1798), 
and continued till the month of Frimaire 
(middle of November) in the year 7 (1799). 
More than two-thirds of the army were 
attacked almost at the same time, which 
made the duty of the garrisons very severe. 
This disease harassed not only our soldiers, 
but also the inhabitants of Lower and Up- 

( 117 ) 

per Egypt. The common duration of the 
ophthalmy was from seven to eight days. 
I have seen a great many recover in less 
time, and I have seen others continue to 
suffer under it for several months. 

Manv individuals, after having been 
cured of ophthalmy once, were attacked 
again. I had a little Maltese servant, who 
had this disease euery time that he slept in 
the open air. 

Those who took care to manage them- 
selves as they were ordered, recovered per- 
fectly in a short time ; others had a great 
deal of difficulty in getting rid of this dis- 
order; and some who unfortunately were 
at a distance from all medical assistance, 
contracted very complicated organic affec- 
tions, which often terminated in the total 
loss of the organ of sight. 

Description of the Ball of the Eye. 

The wish which several very respectable 
persons have expressed of having first some 
ideas of the organization of the ball of the 

( 118 ) 

eye, has induced me to give the following 
short description : 

The eye is composed of three coats, which 
are, the cornea, the choroid, and the retina; 
and of three humours, namely, the vitreous, 
crystalline, and aqueous. 

The cornea is divided into the transparent 
and opaque cornea. 

The opaque cornea is the most external 
coat, or what is commonly called the white 
of the eye •> its texture is very compact, 
and like that of the cornea: it extends from 
the bottom of the eye forwards to the an- 
terior part, where it meets the transparent 

The transparent cornea is the most ele- 
vated part, commonly called the black of the 
eye, and may be compared to the glass of 
a watch set in its case. 

The transparent cornea is composed of 
a great many very minute diaphanous la- 
minae, placed the one over the other, and 
has a serosity which exudes through the 
pores of these lamina?. 

The choroid is a coat like the sLin o( a 

( H9 ) 

black grape; it is spread all over the opaque 
cornea, from the bottom of the eye to its 
junction with the transparent cornea. 

The retina is a coat formed by the ex- 
pansion of the optic nerve : it is very mi- 
nute, soft, of a whitish colour, and spread 
over the bottom of the eye. 

The optic nerve is a round white cord, 
v/hich extends from the brain into the ca- 
vity of the eye, where it is expanded, and 
forms the retina. 

The cavity of the eye is divided into two 
chambers, the one called the anterior, and 
the other the posterior chamber: the first 
is very small ; the second forms almost the 
whole cavity of the eye. 

The diaphragm, or membranous circle, 
which divides the cavity of the eye, is cal- 
led the iris. This very delicate and minute 
membrane is contiguous to the termination 
of the transparent cornea, at the place 
where it is united with the opaque cornea, 
and has in its middle a small hole called the 
pupil, which contracts itself in a strong light, 
and dilates itself in a weak light. The 

t 120 ) 

colour of the iris varies, and according to 
its varieties, the eyes are black in some 
persons, and blue in others. 

The posterior chamber of the eye is filled 
by the vitreous and crystalline humours, and 
the anterior by the aqueous humour. 

The vitreous humour is so named from 
its resemblance to melted glass : it is formed 
by an extremely fine coat, which includes 
in its cells a kind of gummy water. 

The crystalline is a little transparent 
body, like a diamond, of a lenticular form, 
convex on its two sides: it is placed on the 
anterior part of the vitreous humour, imme- 
diately behind the pupil, where it is retained 
by a very minute coat, called the crystal- 

The anterior chamber comprehends the 
space which remains between the crystal- 
line lens and transparent cornea, where we 
find the aqueous humour, so called from its 
resemblance to water. 

The rays of light which convey to the eyes 
the images of bodies, undergo a refraction 
in passing through the transparent cornea 

( 121 | 

and aqueous humour : after having passed 
through the pupil, the crystalline lens causes 
them to undergo one still greater, which is 
lessened by the vitreous humour, and the 
image is stopt by the retina, the seat of 

The ball of the eye is covered by two 
eyelids, the one the superior, the other the 
inferior; and we distinguish here two angles, 
the one the large, or internal, the other the 
small, or external. The eyelids, or palpe- 
bral, are formed by strong minute liga- 
ments, which support two small curved car- 
tilages, running lengthwise on their edges, 
which are called tarsi : these tarsi, towards 
the great angles, have two holes, called la- 
chrymal points ; they are fringed with hairs, 
known under the name of cilia. The 
palpebral are covered by the common in- 
teguments, and are lined internally by a 
soft flaccid membrane, known by the name 
of conjunctiva, which is stretched over the 
surface of the eye as far as the transparent 
cornea. The inner surface of the palpebral 
is furnished with a number of follicles, 

( 122 ) 

called the glands of Meibomius, which se- 
crete from the blood a peculiar fluid for the 
purpose of keeping the eye moist, and les- 
sening the effects of friction, which results 
from the continual winking of the palpe- 

A small gland, situated under the smaller 
angle of the orbit, furnishes the tears, and 
is called the lachrymal gland. 

At the great angle of each eye we ob- 
serve a little reddish tubercle, which se- 
cretes a mucilaginous fluid, that contributes 
to retain in the great angle, the dust and 
other foreign matter which are casually 
blown into this part. I saw, in Egypt, 
-several individuals who had hairs in this 

The fluids secreted by the lachrymal 
glands, the serosity which exudes through 
the pores of the transparent cornea, the 
fluids of the glands of Meibomius, and of 
the tubercles, after having moistened thebali 
of the eye, are absorbed by the lachrymal 
points, and carried into the lachrymal sac, 
and from that by the nasal canal into the 

( 123 ) 

hostriis. All these parts have, in their 
organization, arteries, veins, nerves, and 
lymphatic vessels, which it would be too 
tedious to detail. 

Description of the Ophthalmy. 

The ophthalmy of Egypt first showed it- 
self by a slight head-ach : sometimes it was 
preceded by a few shooting pains in the ball 
of the eye, followed by a flow of tears, 
which, for the moment, assuaged the pain : 
often the patient fancied that he had a par- 
ticle of sand in his eye, which distressed 
him. We generally remarked, that those 
in the best health were attacked all at once 
with ophthalmy, accompanied with an un- 
easiness and considerable weisrht in the 
eyes, followed by an excessive flow of scald- 
ing tears, to make use of the expression of 
the sick. On examining the eyes in this 
state, the vessels of the conjunctiva ap- 
peared red and distended ; often the con- 
junctiva was elevated to such a degree, that 
Jhe transparent cornea appeared quite bu- 

t 124 ) 

ried in it, and of very small diameter. Then 
the palpebral became cedematose, the pa- 
tient could no longer endure the light, the 
flow of tears increased, and generally be- 
came changed into a thick, and sometimes 
yellow matter.* 

I think we may call the ophthalmy, ar- 
rived at this stage, although very severe, 
the simple ophthalmy ; and the ophthalmy 
complicated, when the gorging of the con- 
junctiva, the swelling of the palpebral, and 
the pain of the eyes became so consider- 
able, that fever showed itself, and some in- 
jury or organic lesion was perceived in the 
ball of the eye, as specks, staphylomas, hy- 
popius, and other diseases peculiar to this 

* This matter was nothing more than the fluid of the glands, 
or follicles of Meibomius, which the inflammation had ren- 
dered thick. We see this change happen to the skin in slight 
burns, and after the action of cantharides ; for the first day 
there is nothing poured out from the affected parts but lymph, 
the day after, thicker matter, which finally becomes changed 
into true pus. The inflammation of the conjunctiva, in the 
ophthalmy of Egypt, and that of the membrane of the urethra, 
afford discharges, of which the appearance is exactly similar. 

( 125 ) 


With regard to the cause of the ophthal- 
my of Egypt, some say that it is the sands of 
the desert which bring it on ; others, that 
it is ammoniac mixed with the dust ; and 
others that it is nitre. Savaresi says, that 
the nitrate of pot-ash, which has been im- 
properly called nitrous dust, does not at all 
injure the eyes, but that it is the clay which 
has alumine for its base, and the chalk, 
which is a combination of the carbonic acid 
with lime, earthy substances widely scat- 
tered over the whole soil of Egypt, which 
cause the ophthalmy. (See the Egyptian 
Decade, vol. ii. page 161.) 

Amongst the causes, I consider the in- 
tense light of the sun as the principal, and 
that what contributed most to cause a de- 
termination to the delicate parts of the ball 
of the eye, was a considerable degree of ir- 
ritation, followed by an indirect debility, 
to make use of the Brownonian expression. 
It is not in Egypt only that we find com- 

( 126 ) 

plicated diseases of the eyes, but in many 
other places. At Bologna in Italy, for ex- 
ample, when a stranger arrives there, he is 
not long in remarking a considerable num- 
ber of blind people, who, during the day, 
sing and play on different instruments in the 
squares of this great city: one also observes, 
there a great many individuals, who have 
the eye-ball projecting, and more bulky than 
in its natural state, and staphylomas, specks, 
and other defects of that kind. It is well 
known that these affections are the conse- 
quence of different inflammations caused by 
the light of the sun reflected from the walls 
of the houses, which are white-washed with 
lime. This light, during the summer, be- 
comes so intense, that it fatigues and in- 
jures the organ of sight, particularly in those 
persons who, from their sphere in life, or 
property, cannot avoid it. (See the Memoires 
de la Institut de Sciences de Bologne.) 

At Malta, in the year 7 (1799), one half 
of the garrison was attacked with the me- 
ralopie. This disease was attributed to the 
too great irritation caused by the rays of the 

( 127 ) 

sun reflected by the surface of the walls, 
and from the ground, which is composed 
of very white calcareous earth.* 

In Egypt the view of immense barren 
plains, the reverberation of the rays of the 
sun, reflected from the ground, intersected 
with streets and squares, and from the water 
and sandy banks of the Nile, the heat and 
blaze of which are so great at mid-day, that 
the eye can scarcely see the spot where one 
wishes to place one's foot, must necessarily 
enfeeble, fatigue, and dispose the organ of 
sight to particular affections. The masons 
of Egypt being more exposed to this glare 
of light than others, have almost all dis- 
eased eyes. Savaresi asserts that this arises 
from the lime which they are constantly 
handling, and from the atmosphere in which 
they live, being loaded with chalky, argil- 
laceous, and calcareous particles. The fol- 

» Citizen Rober, physician to the army of the East, at the 
head of the hospital s'taft" of the island of Malta, has made 
some very interesting remarks upon this disorder, on the topo- 
graphy of the island, and the physical and medical constitu- 
tions of the years 6, 7, and 8 (1798, 1799, and 1800). It is 
to be wished, for the benefit of the profession, that he may 
commit this work to the press. 

( 128 ) 

lowing fact appears to me to prove com- 
pletely, that the calcareous particles dif- 
fused in the atmosphere do not produce the 
mischief which is apprehended. In the 
hospital at Giseh, at the time of its first es- 
tablishment, the wards were white-washed, 
or rather laid over with a very thick stra- 
tum of lime, applied to the walls by means 
of a miserable broom of osiers, according 
to the manner of the country. The walls 
exhaled, for several days, a very strong 
smell peculiar to lime, which certainly arose 
from minute calcareous particles, which, 
having become very dry, diffused themselves 
in the atmosphere of the wards. This hos- 
pital was appointed to receive the soldiers 
attacked with the ophthalmy, who were to 
come to it from the hospitals at Cairo, and 
who actually arrived to the number of about 
one hundred, towards the end of Frimaire, in 
the year 7 (middle of December, 1799), the 
walls being scarcely dry. Having the care 
of these men, who had been for a long time 
suffering under the disease of the eyes, I 
was very uneasy lest I should see them lose 

( 129 ) 

their sight entirely j but I was agreeably 
surprised on finding them all a great deal 
better on the following day. Citizens Cha- 
teau-Neuf, Dumay, Cerresoli, medical offi- 
cers, and all the persons attached to this 
hospital, can attest the truth of this amelio- 
ration, which was attributed to the situation 
being less damp than the wards from which 
they had come, and tp the leaving off the 
emollient and aqueous collyria, of which 
they had before been making abuse ; and 
perhaps to the stimulant action of the cal- 
careous exhalations. 

But thismuch r however, is certain, that if 
the dust or the sand of the soil of Egypt 
were the cause of the ophthalmy, this ma- 
lady would not cease attacking the inhabit- 
ants during the whole course of the year, 
with the same violence, since there is hardly 
a day passes without one's being obliged to 
walk in a kind of thick mist, or in whirl- 
winds of dust, elevated by the winds, by 
men on foot and on horseback, and by the 
camels and asses. To prove this fact, I ap- 
peal to those persons who have frequented 

( 130 ) 

flie highways of Bulac and Old Cairo. If 
this dust, blown into the eyes, were the sole 
cause of the ophthalmy, when there was no 
dust we ought to have been exempt from 
it. We, notwithstanding, experienced the 
contrary in the Delta, and particularly on 
the cultivated banks of the Nile, during the 
time of its inundation. Whenever we were 
there exposed to currents of air during the 
night, we were immediately attacked with 
this disorder, without being able to attri- 
bute it either to the sand or dust, which 
were then under water. It was more par- 
ticularly, I repeat, during the inundation 
of the Nile, that a great number of our sol- 
diers were attacked with the ophthalmy. 
(See the Egyptian Decade,) How came 
the French of the division Dessaix, to re- 
turn from Upper Egypt to Cairo attacked 
with ophthalmy, although they had been 
constantly embarked upon the Nile ? I ob- 
served that the sappers appointed to manage 
the flying bridge established on the Nile, 
between Giseh and the isle of Raoudah, 
were all attacked with this disorder ; and I 

( 131 ) 

have seen a number of persons who had 
contracted this disease, although they had 
never stirred out of their houses, which were 
perfectly secured from any dust. 

Having the charge at Cairo of the surgi- 
cal duty of the military hospital No. 1, I 
remarked that several wounded men con- 
tracted the ophthalmy, from merely having 
been placed near to a window not properly 
closed, or in a wretched ward, which had 
been roofed over with mats laid at such a 
distance from each other, that in several 
places one might have observed the course 
of the stars in the meridian. The ophthalmy 
supervening upon these unfortunates in the 
hospital, has been often more difficult to cure 
.than the wounds which brought them there. 
It cannot be said that it was the dust blown 
through the windows which was the cause 
of the malady, since at that time the squares 
of Cairo were still inundated, and particu- 
larly that of Beker-Tell-Fild, which that 
very hospital overlooked. This was in Bru- 
maire of the year 7 (October, November, 


( 152 ) 

Nevertheless, I do not pretend to say that 
the dust of the soil of Egypt may not be 
hurtful to the eyes, but I think that alone 
it is not sufficient to excite ophthalmy ; and 
it appears to me more probable, as I have 
already said, that this disease arose from the 
suppression of perspiration, which takes 
place very often in Egypt, particularly at 
night, and which throws itself on the weakest 
part, choosing sometimes the intestines, and 
oftener the eyes, fatigued by too vivid light 
of the sun. Such is, in my opinion, the real 
cause of the ophthalmy of Egypt. 


In the general treatment of ophthalmy, 
it is proper, first, to draw off into other 
channels the blood and fluids, which are 
carried to the eyes in too great quantity. 
Secondly, to restore their tone to the coats 
and the other parts of the eye, which are 
too much relaxed. 

( 133 ) 

General Treatment of the Ophthalmy. 

Atony, relaxation, and asthenia, were 
constantly combined in the ophthalmy of 
Egypt, denominated with propriety the 
lymphatic inflammation (iippitudo) of the 
ancients. I had many opportunities of see- 
ing and treating this disease in several hos- 
pitals, and particularly at Giseh, a place 
situated about half a league distant from 
Cairo, on the left bank of the Nile, sur- 
rounded by walls on the south and the. 
west, and washed by the river on the east 
and north sides. During the time of the 
overflowing of the Nile, several fields and 
gardens situated within the precincts of 
the walls of Giseh, were inundated. The 
great workshops of the park of artillerv lay 
quite close to these waters ; the northerly 
winds prevailed constantly ; the quarters of 
our workmen and soldiers were not at all 
secured from the cold air and the damp, 
which penetrated into their chambers with 
as much facility during the night as the heat 

{ 134 ) 

and excessive light entered them during the 
day. These inconveniences were the princi- 
pal causes which occasioned the ophthalmy 
to show itself more at Giseh than elsewhere. 
To these common causes may be added 
those which are peculiar to blacksmiths, 
founders, tinmen, locksmiths, armourers, 
farriers, bakers, &c. who, from their em- 
ployments, are exposed to the heat and 
light of burning coals: in spite of which, 
during the six months that X had the chief 
charge of this service, I had the satisfaction 
of seeing all those affected recover, and in 
a very short time. Of two thousand at- 
tacked with the ophthalmy, whom I at- 
tended in Egypt, not one lost his sight, ex- 
cepting the Abbe Elias, interpreter, a man 
sixty years of age, and who at last con- 
tracted a speck, which prevented him from 
seeing with the left eye. 

In the treatment of this disorder, I re- 
commended them not to make use of any 
cataplasm, to banish milk, washes, and 
emollient collyria. I followed the custom 
of the people of the country, who look upon 

( 135 ) 

water as most injurious to the eyes. In 
truth, the abuse which was made of it could 
not fail to weaken and obstruct still more the 
parts already too much relaxed. We all 
know the inconveniences resulting from 
wetting the eyes day and night, or keeping 
wet linen rags on the palpebral. Water too 
frequently applied to the external surface of 
the palpebral and forehead, the neglect of the 
means acknowledged to be useful, and the 
abuse of remedies administered by quacks, 
were the sole causes which produced the 
bad cases of this disease. At Belbes, a sol- 
dier attacked with the ophthalmy experi- 
enced such violent pains in his eyes, that, 
being almost frantic, he rushed out of his 
lodging, and without seeing where he went, 
beean to run backward and forward. This 
unfortunate man fell over a heap of pines 
and palm-trees, and by his fall wounded 
himself in different places, particularly on 
the palpebral, from which there followed a 
good deal of blood : the pains were relieved, 
and he recovered in a few days. 

It was after this accident that bleeding 

( 136 ) 

came into vogue, and there was not a single 
patient who did not desire to be bled either 
in the arm, foot, jugulars, or temples; but 
we very soon discovered that it was blood 
very unprofitably lost. We then substituted 
successively the use of leeches, scarifica- 
tions, blisters, and finally setons. These 
means were found, in general, more ap- 
propriate, and we should have derived from 
them much greater advantage, if the sick 
would have desisted from wetting their eyes 
so often. 

Treatment of the simple Ophthalmy. 

Citizen Bonaud, commissary of war, 
charged with the service of the park of 
artillery, a man very well known by his 
talents and zeal, had seconded me in esta- 
blishing a little pharmacy, and consulting 
room, where such sick as were able to walk 
came to me every morning. 

I immediately administered to them the 
remedies which I thought necessary. I 
gave, at the same time, to those with the 

( 137 ) 

ophthalmy, a weak solution of verdigrise, 
prepared according to the method of Janin,* 
oculist at Lyons, more or less strong accord- 
ing to the degree of turgidity of the vessels 
of the conjunctiva. When there existed 
too great a degree of sensibility in the parts, 
I added to the collyrium a small quantity 
of the acetite of lead, and I showed them 
the manner of using it, which consisted in 
opening the eyelids widely, and letting fall 
directly on the ball of the eye one or two 
drops, or more, which diffused themselves 
all over the surface of the conjunctiva. 

This fluid produced at the moment a 
slight pricking, followed by some tears, 
which served to wash the edges of the eye- 
lids. I desired this operation to be repeated 
at least four times a day, recommending to 

• Mr. Janin's formula is as follows: 
R. Aq. Rosae. 

. Plantaginis. an ? vj. 

Zinc. Vitriolat gr. xxiv. 

Pulv. Rad. Iridis. Florent. gr. xxxvi. 

Ptilv. JFruginis. gr. xij. M. bene in mortario tit 

it. collvrium. He observes, that it is an excellent remedy ia 

the early stage of ophthalmy, as it prevents the constant flow 
of tears; and that it also improves the sight of aged and short- 
sighted persons. See Janin Mem. et Observat. &c. sur l'(Eil>. 
Paris, 1772. T. 


( 138 ) 

the patients to wipe their eyes frequently 
with a bit of rag kept for the purpose, but 
not to wash them. I at the same time made 
them sensible of the necessity of keeping 
themselves well covered during the night, 
and protecting their eyes during the day 
from the excessive light, by making a kind 
of shade with their handkerchief, without 
bandaging their eyes as they had before 

The facility with which the simple oph- 
thalmy got well, according to this method, 
confirmed me in my opinion, that it was a 
true defluxion of humours, which might be 
compared to a coryza. 

I was obliged sometimes to make use of 
^rnall blisters applied to the temples, or be- 
hind the ears: I preferred, for this purpose, 
a blistering plaster, which I allowed to 
remain applied during the whole of the 
attendance, without changing it, or making 
use of any bandage. I have employed, 
with advantage, small plasters of this paste, 
immediately over the teguments of the pal- 
pebral, in order to remove their swelling 

( 139 ) 

and atony. In proportion as the symptoms 
of ophthalmy diminished, I made my colly- 
rium more tonic, not only to assure myself 
of the cure, but also to prevent a relapse; 
without which precaution this accident hap- 
pened very frequently, and then the disorder 
became more obstinate, and frequently com^ 

When those attacked with ophthalmy 
were of a plethoric and sanguine tempera-*- 
ment, I had recourse to blood-letting ; when 
their bowels were constipated, I prescribed 
purgatives, and I followed exactly the ad- 
vice of Hippocrates, who has told us, Ocu- 
lorum JluxioneSy alvi Jlyxii carantur. This 
practice became still more necessary, when 
the ophthalmy had succeeded to diarrhoea., 
which happened very frequently in Egypt, 

Treatment of the complicated Ophthalmy. 

The complex ophthalmy varied accord- 
ing to the nature of the organic lesion of 
the affected parts, the degree of the disease, 
and other accidental circumstances, 

( 1^0 ) 

It constantly happens that r in all obsti- 
nate ophthalmies, all the functions become 
deranged, and particularly that of the sto- 
mach : hence, affections of this viscus were 
very frequently complicated with the oph- 
thalmy, which then yielded to the repeated 
use of emetics and purgatives. 

Often the most severe symptoms accom- 
panying ophthalmy arise from a state of 
extreme sensibility in the patient, and we 
then find symptoms decidedly nervous. One 
of my colleagues (Citizen Cerresoli), during 
his attack, was in a such state of agitation, 
that he often found himself forced involun- 
tarily to shed scalding tears. 

In the complicated ophthalmies, along 
with a great sensibility of the nervous sys- 
tem, there came on the most violent pains 
in the head, the pulse became high, the 
patients could obtain neither ease nor sleep, 
and as they were deprived of sight, the fear 
of remaining in that situation augmented 
the uneasiness of the sufferer, to whom it 
became necessary to give soporifics and ano- 
dynes, to which was added blood-letting,. 

t E« ) 

when' the strength and constitution per- 

When the ophthalmy approached its ter- 
mination, the patient began to distinguish 
objects, which appeared to him surrounded 
with a thick mist ; this mist disappeared 
by little and little: the conjunctiva re-' 
covered its natural colour instead of the 
purple hue which it had before; the exces- 
sive sensibility of the retina diminished ; 
and, at length, after a good deal of time, 
trouble, and suffering, the patient found 
himself quite recovered. But when the oph- 
thalmy became complicated with organic 
lesion, the consequences were much more 
troublesome; the treatment varied accord- 
ing to the seat and nature of the affection; 
sometimes the conjunctiva was so very 
turgid, that it projected quite beyond the 
palpebral, which then could not entirely 
cover it. In this case, besides the common 
remedies, we recommended and practised 
scarifications, and even horizontal incisions, 
thereby removing whole portions of the 
conjunctiva; but I observed that this prac- 

{ 142 ) 

tice was seldom productive of any good ef- 
fects: therefore I prefer the application of 
leeches, which bring away a greater quan- 
tity of blood. The use of the citron oint- 
ment, No. 14, was of some use, and gradu- 
ally removed the turgidity of the vessels of 
the conjunctiva. 

At other times the portion of the conjunc- 
tiva lining the palpebral, became so volu- 
minous, that these were reverted, producing 
the most hideous effect : we then made use 
of the same remedies as in the turgidity of 
the conjunctiva. A bandage indeed was 
suggested, to compress and retain in its po- 
sition the superior eyelid, after having care- 
fully replaced it; but it very soon became 
reverted anew. 

The majority of those individuals who 
were attacked with this particular affection, 
had, at the same time, some other defect 
in the ball of the eye: in some the whole 
of the transparent cornea was become ei- 
ther opaque, or projecting, or ulcerated. In 
this last case, the transparent cornea being - 
no longer able to resist the pressure of the 

( 143 ) 

humours contained within the eye, gave 
way, and the patient at this moment expe- 
rienced a shock which he compared to the 
shot of a pistol, the aqueous humour escaped 
as at the moment of the incision of the cor- 
nea in the operation for extracting the ca- 
taract, and the iris coming into contact 
with the cornea, adhesion of these parts 
took place, and cut oft every hope of re- 
storing: sight to these unfortunate sufferers, 
When specks arose from pus collected be- 
tween the laminae of the transparent cornea, 
they disappeared on giving the matter vent ; 
and when produced by the inflammation of 
the cornea, they vanished and re-appeared, 
in proportion as the inflammation dimi- 
nished or increased. 

In several soldiers whom I accompanied 
from Egypt to France, I observed that the 
specks which they had at their departure 
from Alexandria, were diminished after 
some days sail ; and on their arrival in France 
they clearly distinguished objects, not only 
sideways, as before, but when placed di- 
rectly before them. I know some of these 

( 144 ) 

"Individuals, who had been reported as in- 
valids in Egypt, and who are at this time 
in the Consular Guards. Whenever the 
specks on the transparent cornea do not 
arise from the disorganization of its lamina?, 
there is always reason to hope that the 
lymphatic vessels will absorb the extrava- 
sated and thickened fluids forming these 
specks ; but whenever the organization is 
so much changed, that the transparent cor- 
nea is become opaque in its centre, then 
there remains no other method of restoring 
vision, but performing the operation for the 
artificial pupil.* 

The staphylomas, hypopions, cataracts, 
and other similar consecutive diseases re- 
quire particular treatment, and the most 
delicate operations, which it was not always 

* I had made at Reggio, in 1788, a small pair of forceps for 
separating a portioiuof the iris from the opaque cornea, and 
making in this manner an artificial lateral pupil, in the form of 
a crescent. In the year 5 (1797), Citizen Demours, a celebrated 
oculist in Paris, succeeded in making an artificial pupil, by cut- 
ting off a small slired quite close to the opaque cornea, where 
there did not remain above a fifth of the transparent cornea in 
a natural state, and separated from the iris. This operation has 
been followed with the greatest success, and proves the daily- 
progress of surgery in France. 

I H5 ) 

prudent to undertake in Egypt. Citizen 
Larray performed at Cairo some operations 
of this kind with various success. This in- 
genious and zealous practitioner was one of 
the foremost in applying himself to inquiries 
into the nature of the ophthalmy, and pre- 
sented to the Institute of Cairo a very full 
account of this disease. Citizens Bruant and 
Savaresi have also inserted some reflections 
on this subject in the Egyptian Decade. 

The Treatment used by the Egyptians for the 
Cure of tlie Ophthalmy, 

When the natives of Egypt are attacked 
with the ophthalmy, they cover their eyes 
•with several muslin handkerchiefs, and are 
very careful not to touch or apply any thing 
•to them during the first seven days. At night 
they cover, with great care, their head and 
body, by which means the perspiration is 
restored, which greatly contributes to their 
recovery in a short time. Often severe symp- 
toms show themselves ; and then they make 
use of various powders, and astringent and 

( 146 ) 

tonic collyriums. (See the table, p. 148.) 
Several have their heads shaved, and scarifi- 
cations made on their temples and fore- 
heads; they apply leeches to the angles of 
their eyes, and cupping-glasses to the nape 
of the neck,* blisters behind the ears, where 
they also sometimes apply cautery; they, at 
the same time, make use of different oint- 
ments, and coloured and thick collyriums; 
for if the Collyriums were liquid and trans- 
parent, they would, in their opinion, be 
iiurtful and injurious to the eyes. 

At Giseh, and other places, I have seen 
them paint their eyebrows and all the edge 
of the orbit, with a pencil dipt in a mix- 
ture, either white or yellow, or sometimes 
black. It was difficult to keep oneself from 
laughing at seeing these poor sick people 
almost blind, with the contour of their 
eyes besmeared with these different colours. 

* The Egyptians, for performing this operation, make use of 
a small cow's horn, open at its base, the other extremity also 
open, and provided with a kind of parchment valve : they 
place the base of this horn upon the skin, at the spot where 
they wish to perform their cupping ; they then exhaust the air 
by means of suction, and after having in this way formed the 
necessary vacuum, rhey close the valve, which prevents the en- 
trance of the external air into the cavity of the horn. 

( 1'47 ) 

They were expressly forbid to touch, wash, 
or cover their eyes, and were not to use any 
other remedy for three days, if they wished 
to get well. 

The astonishing number of persons of 
both sexes, blind in one or both eyes, whom 
one meets with in Egypt, proves that theii 
treatment is not at all efficacious. Indeed, 
in the complicated ophthalmies, what can 
we expect from such remedies, but loss of 
eyesight, as some of our soldiers experi- 
enced who were thus treated. 

I agree with the inhabitants of Egypt, 
that emollients, cataplasms, and water, are 
hurtful in the cure of this disorder ; but I 
assert likewise, that to neglect every kind of 
remedy is to confide too much to nature, 
and too little to the resources of art. Their 
principle of fatalism, God decrees, God has 
decreed, makes them neglect many things 
which might be of utility to their health.* 

* Amongst the great number of blind people whom I ex- 
amined at Cairo, I saw very few individuals who had true ca- 
taracts capable of being operated upon with success. The ma- 
jority had either staphylomas, or the cornea totally opaque, or 
the eyes almost entirely evacuated. When I proposed to cure 
those having cataracts by means of a small incision, they r<S 

( 148 ) 

Powders, Ointments, and Collyriums, used 
in Egypt in the Treatment of the Opk- 

No. 1. Nat galls and pulverized anti- 
mony, each equal parts; mix and make into 
a powder. 

No. 2. This powder, mixed with vine- 
gar, forming a kind of ink. 

plied to me with the greatest coolness, 1 shall be cured without 
any incision if God decrees it: and it was not possible for me to 
persuade any of these fatalists to allow the operation to be per- 

Citizen Berti, of Venice, surgeon oculist, only performed 
at Cairo, during eighteen months, two operations for the ca- 
taract, on two beys, with whom lie was very much displeased, 
because, after having completely cured them, they said that 
they could not see so well as formerly, and that the operation 
had been badly performed, because he had not evacuated the 
humours of their eyes with his lancet. This instance of the folly 
of the Turks made me determine to abandon the operation for 
the cataract, to which I had paid a good deal of attention when 
in France and Italy, where I had practised it with success, both 
according to the method of Demours, and with an instrument 
of my own invention, which bears some resemblance to that of 
Gueiin. I had this instrument made at Paris in 1786: it was 
presented to the Academy of Sciences by Citizen Sebatier, who 
wished much to read to them my sentiments upon that instru- 
ment, and likewise upon that of Citizen Guerin, of Bcurdeaux, 
which had then appeared at Paris. 

Citizen Malacarne, professor of surgery at Padua, had these 
same reflections, and the case in which I had made use of my 4 
instrument with success, inserted some time afterwards in the 
Journal of Citizen Bragnatelli, entitled, Bibliotheca Physico 

( 149 ) 

No. 3. Sugar-candy, sulphate of alumine, 
nitrate of pot-ash, equal parts ; mix and 
make into a powder, for destroying specks 
on the cornea. 

No. 4. Chichm* in powder, sugar-candy, 
alum or sulphate of alumine, equal parts; 
mix the whole with vinegar. 

No. 5. Infusion of saffron, and some drops 
of the tincture of opium as a resolutive 
anodyne collyrium. 

No. 6. The soap collyrium, a solution of 
soap in alcohol. 

No. 7. The tonic collyrium, a solution of 
the sulphate of zinc in water, mixed with 

* The -chichm is a black seed very common at Cairo : it is 
brought by the caravans from Darfour and Senaar. Citizen 
Delille, member of the Institute of Cairo, sowed this seed in 
Egypt: it gave the cassia, absus; Linnaeus, cr.ssia hispida ; of 
■which he communicated to the Institute of Egypt, and that of 
France, the following description : — The cassia, absus, is a 
small hairy plant, whose stalk is slender and herbaceous, ics 
ieaves alternate, pinnate, composed of two pairs of leaflets, 
occupying only the upper part of the plant. The flowers arc of 
a deep yellow, and disposed in little loose clusters; they pro- 
duced hairy, narrow, compressed pods, about five centimetres 
in length (one inch), enclosing black roundish-oval shining 

Citizen Fontaine, professor at the Jard'm des Plantes, told 
me, that about three years ago Citizen Olivier, member of the 
Institute, had brought this seed from Persia, under the name of 
cassia, absus; that these seeds had been sown in the Jard'm des 
Plantes; and that they also had produced the cassia hispida. 


( 150 ) 

vinegar and brandy ; useful in affections of' 
the palpebral and tarsi. 

No. 8. Muriate of soda, dissolved in 
water, mixed with vinegar ; useful in the 
simple ophthalmy. 

No. 9. Solution of verdigrise. 

No. 10. Solution of acetite of lead. 

No. 1 1 . Cerusse mixed with water, used 
to paint the contour of the eyes white. 

No. 12. Saffron bruised and mixed with 
cerusse, and a little vinegar, for painting in 

No. 13. Ink of antimony, for painting 
in black. (See No. 1.) 

No. 14. The desiccative ointment, made 
by adding some oxyde of mercury, formed 
by the nitric acid to any ointment. 

No. 15. The vegeto-mineral water. 

On the Means of preventing the Ophthalmy. 

We have already said that it was not at 
all difficult to preserve oneself from the 
ophthalmy, provided we keep ourselves pro- 
tected from the currents of cold and damp 

( 151 ) 

air, it being well known that this precaution 
alone is sufficient. At Cairo, the Monks 
and Franks, and also those inhabitants who 
adopt proper precautions, are not at all sub- 
ject to this disease, 

The soldiers on guard, or upon night 
piquet, should, during the night, cover up. 
well both their head and feet, and particu- 
larly if they are obliged to make a voyage 
on the Nile; and in cold and damp places, 
they should avoid, as much as possible, the 
smallest currents of air. Several persons 
have been attacked with the ophthalmy 
after having slept near a window which had 
not been properly closed. IX was in this way 
that Citizen Fevre, engineer of bridges and 
causeways, and member of the commission 
of arts, was attacked with the ophthalmy 
in one eye, the first night after his arrival 
at Cairo from Syria, although he had slept 
the preceding nights in the open air, in a 
bark on the Nile, without experiencing the 
smallest inconvenience, because he had 
taken care to keep himself well covered . He 
had a great deal of difficulty in getting rid 

( 152 ) 

of his ophthalmy; and if he neglected for 
a single day to make use of the collyrium 
(No. 9), he was attacked without fail on 
the day following. We have remarked, 
that this collyrium prevented or stopt the 
progress of the ophthalmy ; and I have no 
doubt that it might also be useful as a pre- 
servative.. This slight styptic must neces- 
sarily act upon the vessels of the conjunctiva, 
the lachrymal ducts, the glands of Meibo- 
mius, the lachrymal caruncle, the pores of 
the cornea, and- preserve these parts from 
that state of relaxation which is the princi- 
pal cause of the ophthalmy of Egypt, and 
of a great many of those of Europe. 

The- general of division, Beillard, was 
severely attacked with the- ophthalmy at 
Giseh, while he commanded that province. 
He attributed his cure to that same collyri- 
um ; and sometime afterwards, having gone 
into Upper Egypt, I sent to him, as a pre- 
servative, a mixture of verdigrise and ace- 
tite of lead in powder, which he dissolved 
in rose-water. When he happened to be 
short of the collyrium, I recommended to 

( 153 ) 

him the use of a mixture of brandy and pure 
water. The ointments, besides other in- 
conveniences, were very apt to turn rancid. 
In order to diminish the impression of the 
light, green spectacles have been recom- 
mended. This method is very good, but 
one must use spectacles a little better made 
than those which the Turks sold to us. 
They consisted of a half-mask of Morocco 
leather, furnished with two miserable pieces 
of coloured glass, pasted between two bits 
of leather : they lay too close upon the eye^ 
and heated them very much. Indeed, all 
those who used them, laid them aside in a 
short time, after having experienced not only 
their inutility, but also their inconvenience. 
As to myself, I never made use either of 
spectacles, of collyriums, nor of any pre- 
servative to protect me from the burning 
sand, the nitric, ammoniacal, or calcarious 
dust, nor even to protect myself from the 
excessive light : but at no time either the 
refreshing coolness of the evenings, or the 
beauty of the nights, could induce me to 
leave my windows open, or to sleep in the 

( rat ) 

open air; and when I was obliged on duty 
to do so, my boat-cloak served me for a 
tent, and became my segis. 

Note. I have no doubt that the catarrhal ophthalmy which 
prevailed at Vienna, in Germany, in 1799, was of the nature 
of the Egyptian ophthalmy. (See the Bibliotheq. Germanic, 
torn. iv. page 132.) 

j( 155 J 





Attacked in Egypt with the Disease 
called the Plague. 

J.N speaking of the disease epidemic in 
.Egypt and Syria, called the Plague, we 
pointed out the means to be used for self- 
preservation ; but it must be confessed that 
it is not always in our power to avoid the 
causes which produce itj and the soldiers 
composing the garrisons of Alexandria, 
Rosetta, and Damietta, may be attacked 
with it, particularly during the rainy and 
unhealthy seasons. It is vvell known, that 
in order to cure any epidemic disease what- 
soever, there is nothing more useful than 
to place the sick in healthy, dry, and well 
aired places. 

( 156 ) 

During the twenty years that I have stu- 
died and practised physic, I have seen a 
great many hospitals in Italy, Switzerland, 
France, England, and Egypt, and met with 
many very beautiful; but very few indeed 
which united the advantages necessary for 
the object proposed: that of Reggio is, in 
my opinion, the most healthy, and best con- 
ducted of all those which I have examined 
in detail. As surgeon in chief of this hos- 
pital for nine years together, I had every op- 
portunity of convincing myself of this truth. 
The large hospitals are seldom kept clean, 
and are always unhealthy on account of the 
number of sick brought together into the 
same place. The hospitals which I have 
seen in Lower Egypt, and particularly that 
at Alexandria, called the Hospital for Plague 
Patients, was more adapted for producing 
than for curing the fever. I am also well 
convinced, that it is by no means easy to 
convert churches and mosques into good 
hospitals, notwithstanding the good will and 
talents of the engineers; and if we consider 
the enormous expense which the repairs of 

( 157 ) 

such a place require, before it is converted 
into an hospital, I am certain that one 
might have constructed the whole quite 

It is for the purpose of procuring, if pos- 
sible, for these establishments all the ad~ 
vantages of which they are susceptible, that 
I have conceived the plan of an hospital for 
the garrisons of the principal cities on the 
coast of Egypt. I take for granted, that 
we follow the advice which I gave far pre- 
venting the epidemic fevers of this country 
at the same time; and then an hospital ca- 
pable of holding about one hundred fever 
patients will be sufficient for any garrison 
whatever, either at Alexandria, Rosetta, or 
Damietta; and if experience should prove 
that such an hospital as the one proposed 
will not be sufficient for the number of sick, 
we may construct, at a certain distance, 
another like the first ; but we ought to avoid 
bringing together into the same place too 
great a number of fever patients. The 
crowding together a number of sick in the 
same hospital, has been, and always will 

( 158 ) 

be, contrary to the true principles of the 
practice of physic, whatsoever may be the 
disease; a fortiori, in the treating an epi- 
demic, whose symptoms are such as to have 
procured it the title of the plague. The 
hospital of which I submit the plan, will 
not contain more than one hundred beds : 
it will consist of three wards ; a large one 
for the sick soldiers, a smaller for officers, 
and a third for convalescents. It will also 
have a sudatory, or dry bagnio, for oily fric- 
tions, the whole on the first floor. The 
ground floor will contain the necessary 
offices. This building will be very simple, 
and easily erected, particularly in Egypt, 


There ought to be in each room for the 
reception of patients, a fire-place, a large 
bason, a cistern with a bath, some stone 
seats and presses. 

There should be in the room for warm 
oily frictions, a stove chimney, or a fire-place 
cl la Desamold, and some presses. 

{ 159 ) 

In the great ward there should be two 
tiers of windows, one over the other ; the 
latter should be open down to the floor of 
the wards, the better to renew the air, the 
carbonic acid of which always occupies the 
lower parts of the wards. They should have 
gratings formed of perpendicular bars for at 
least half their height, in order to prevent 
all accidents which might happen to pati- 
ents in a state of delirium. 

Each of these windows, or balconies, 
should be closed by two shutters, which 
should open into the wards ; their upper 
halves should be glazed, and have ventila- 
tors to facilitate the passage of light and 
air into the wards. The shutters of the 
windows should be made to fit well to each 
other, so that they may close accurately. 

The pavement of the wards should have 
some degree of slope inwards, so as to pre- 
vent, in case of any accident, or after wash* 
ing the floor, any moisture remaining under 
the beds, which is a circumstance very es- 
sential to the healthiness of an hospital, and 
generally too much neglected. 

( 160 ) 

The necessaries in that part of the galle- 
ries which we have pointed out, would unite 
the advantages of being without the wards, 
and, at the same time, within the reach of 
the convalescents and those patients able to 
walk. They should be placed in excava- 
tions in the pillars, in the form of nitches, 
and should be paved and lined with marble. 
The water from the roofs should flow off by 
leaden pipes into the necessaries, as well as 
that from the cisterns ; and the troughs for 
the tisans, that from the pharmacy, the 
kitchen, the baths, and wash-house, should 
be carried off into the sea, or the Nile, by 
the same common sewer. 

Such sick as are unable to go as far as the 
necessaries, should be placed, by the assist- 
ance of the attendants, on a copper vessel, 
tinned over on both sides, and the edges 
rounded off, to prevent its hurting the thighs 
of the sick : it should also be pretty strong 
and wide at its base, so as to sustain the 
whole weight of a body without any dan- 
ger of upsetting: it should likewise have a 
cover to fit its opening exactly. Hence, 

( 161 ) 

when thus closed, it will not spread any dis- 
agreeable smell, which is an inestimable ad- 
vantage, particularly to the attendants. The 
earthen utensils commonly used should be 
banished from this hospital, since, if they 
are not quite new, they become infectious. 
If, during some of the days in winter, the 
cold be considerable, which is not uncom- 
mon, particularly at Damietta, it will be 
useful to light pans of coals in the wards, 
which will also help to change the air. 

Among other advantages, attending this 
hospital would be that of having its own 
wash-house and burying-ground distinct, 
and, at the same time, quite near. We have 
all observed with what facility an alarm 
spreads itself in any city which is suspected 
of having the plague, while the sight of the 
dead bodies justifies the dread, and spreads 
dismay. I confess that I never saw any 
thing so hideous and shocking as the. ferry- 
boat into which the dead bodies proceeding 
from the hospitals at Jaffa were thrown, 
for the purpose of being taken out of the 
city to be buried. In the hospital which I 

( 162 ) 

propose, whenever a death happens, the 
body would be immediately removed into 
the dead-room, and afterwards consigned, 
along with some quick-lime and sand, to a 
deep grave in the burying-ground. 

The rose de vents (wind dial), in the in- 
terior of the tower, would point out to the 
officer on guard, whether or not it would 
be preferable to have the windows of the 
south or north sides opened, and whether 
or not the sick should be advised to remain 
in their wards, or to walk on the great 

By the aid of the necessary instruments 
with which modern philosophy has made 
us acquainted, it would be easy to learn not 
only the degree of heat, but all the other 
qualities or properties of the atmosphere. 
These meteorological observations, the me- 
dical topography of the environs of the hos- 
pital, as well as remarks respecting the suc- 
cession of diseases, and their causes, should 
be preserved in a journal kept for this pur- 
pose, which would become valuable towards 
improving the practice of physic. 

{ 163 ) 

Citizen Desgenettes, in Thermidor of the 
year 6 (July 1798), addressed a very inter- 
esting circular letter to the physicians of the 
army of the East, recommending a plan for 
collecting the physical and medical topo- 
graphy of Egpyt. The majority of his fellow 
practitioners complied with the wishes of 
the physician general ; but among their 
reports, I do not find the topographical, 
meteorological, and medical observations 
brought together into one journal, or table, 
as in that which I propose, and which would 
be very easily kept, whenever the medical 
officers were furnished with the necessary 
instruments. Subjoined is the form of a 
table, which would pretty nearly fulfil and 
present atone view the object proposed. 

{ 164 ) 


Made in the Military 

Commencing — — day 

At sun-rise. 

Two hours after mid-day. 

At sun-set. 



f" Sun-rise. 
•s 2 o'clock. 
(_ Sun-set. 






< 2 o'clc 
(_ Sun-si 

f Sun- 
<2 o'c 







of the 


tion of 



In the In the 
ward, open air. 

( 165 ) 


Hospital at 

of the Month — — , of — — year. 








k 166 ) 






( 167 ) 

Practice to be followed on the Beception of 
the Sick into the Hospital. 

Whenever a patient arrives at the hos- 
pital, the porter should show him into the 
small room adjoining the admitting board. 
There he must be examined by the surgeon 
on guard, who, after having made himself 
acquainted with the nature of his disease, 
should give him a billet, with which he 
should immediately pass to the room for 
receiving patients, where the store-keeper 
must make him undo his knapsack, and, 
after taking an accurate account of all 
his property, ought to throw his foul linen 
into a bason full of water, burn his useless 
effects, and then place the rest in the 
magazine tor the knapsacks, and his mus- 
ket and sabre in the room for depositing 
arms : every article should have a ticket 
affixed. The patient, after being stript, 
should be washed with tepid water, and 
rubbed well with soap from head to foot, 
after the manner of the Turks, After this 

( 168 ) 

operation, they should throw over him a 
shirt, a great coat and cap, and give him 
a pair of wooden sandals: he should then 
be conducted to the room for frictions. On 
being brought into this sudatory, he ought 
to be placed on a bed, and one or two hos- 
pital-attendants should begin rubbing him 
rather briskly from head to foot with a 
spunge dipt in warm olive oU. These fric- 
tions must be performed quickly, and .should 
not last longer than three or four minutes at 
farthest: the freshest and purest oil should 
be made use of. If he has buboes, it will 
be sufficient merely to anoint them. The 
patient should be well covered, and will 
then soon begin to sweat j to encourage 
which he should take some tea, or other 
diaphoretic drink. When the sweating be- 
gins to subside, the patient should be again 
dressed in his shirt and great coat, and re- 
moved, well covered, to a bed in the large 
ward, or into the officers' ward. These fric- 
tions should be repeated every day till the 
patient is out of danger; and when the 
physician thinks fit, he should be removed 

( 169 ) 

into the convalescents' ward. It is useless 
to add, that the necessary medicines should 
be administered at the same time, to facili- 
tate the patient's recovery. 

As to regimen, that should be regulated 
by the attending physician. To those at- 
tacked with the plague at Smyrna, they 
give, during the first five or six days, some 
vermicelli, well boiled in water without salt; 
afterwards a little rice, some spoonfuls of 
sweetmeats, a cup of strong Moka coffee, 
and one or two biscuits. When the patient 
begins to get better, they give him some 
soup made with herbs, a little fine white 
bread, a few raisins, and a very ripe orange 
or pear. It is not till after the thirtieth day 
that they give him soup made from meat; 
and about the end of forty days they permit 
him to take a little boiled or roasted veal, 
with a moderate quantity of wine. 

With respect to the duty and employ- 
ment of those attached to this hospital, the 
regulations should be nearly the same as 
those of the other military hospitals of the 


{ 170 ) 

As it is of importance, in order to pre- 
berve oneself from this disease, not to re- 
main too long in the same place, the medi- 
cal officers, and all the attendants, should 
be relieved every two months, or sooner, 
if their health requires it. 

All the persons attached to the hospital 
ought to be lodged out of doors. The sur- 
geon and the apothecary on guard should 
be changed every twenty-four hours, and 
they ought to be at least three days offduty, 
The hospital orderlies, the servants, and 
others attached to the ward for receiving 
patients, to the room for frictions, to the 
wash-house, stores, &c. should do duty al- 
ternately; and when they are not employed, 
they should be prohibited from entering the 
hospital. This measure is of more import- 
ance than may be imagined, since often the 
allurement of a few indirect gains, causes 
them to forget the dangers which they run by 
remaining too long close to the sick. I have 
seen these fellows lavish their attentions on 
some poor wretch, because he happened to 
possess a little money, and they foresaw 

( ^1 } 

that his death was at hand ; but no sooner 
had his purse or his girdle disappeared, thanr 
their assiduities diminished, and the more 
rapidly if some fresh object for plundering 
happened to be presented to these demons 
of avarice. 

It was in this way that several indivi- 
duals contracted the disease, and finished 
their days without enjoying either the spoils 
or compensations which they had scraped 

The salaries of the orderly men, as well 
as their rations of wine, brandy, and coffee, 
ought to be augmented, which would con- 
tribute to preserve them from the epidemic, 
and would induce them to pay attention to 
their duty. 

Before concluding, it will be of some 
utility to mention here some facts which 
have been published by Father Louis, of 
Padua, director of the hospital for plague- 
patients at Smyrna. In 1793 twenty-two 
Venetian sailors inhabited, during twenty- 
five days, a damp chamber on the ground 
floor, along with three persons affected with 

( 172 ) 

the plague, who died: the inunction with 
oil saved all the others. In the same year 
three families of Armenians, one thirteen, 
the second eleven, the third nine in num- 
ber, preserved themselves by the same 
means, and attended on their relations who 
had the plague, without contracting the 
contagion, although they slept on the same 
beds, and supported almost constantly these 
poor creatures in their arms. In 1794 one 
poor woman remained shut up in the same 
apartment, along with thirteen persons hav- 
ing the plague : she nursed them all, and pre- 
served herself from the contagion, by using 
frictions with oil. One Ragusan family had 
that year two of its number attacked with 
the plague : they dipt themselves (if I may 
be allowed the expression) in oil, and, in 
consequence, entirely escaped. At this day 
the use of oily frictions is very generally 
adopted in the Levant. 

Citizen Peron, of Toulon, surgeon of the 
first class in the navy, who has resided at 
Smyrna for several years as a physician, 
communicated to me several particulars 

( 173 ) 

respecting the plague and oily frictions, all 
which have confirmed me in the opinions 
which I have delivered in the course of 
this work. It is to be wished, that Father 
Louis, of Padua, and all those who adopt 
this practice, would publish their observa- 
tions ; since, in my opinion, the frictions 
with oil are not only useful in curing, but in 
preventing the plague. I therefore felt 
anxious to propose the adoption, and to 
detail the particulars to be observed in the 
use of this remedy; and I will add also, 
that I think the use of oily frictions in a su- 
datory (frictions cChuile d. etuve), may be 
made of much more extensive application. 
A great deal might be said on the modus 
agendi of this remedy; but I disclaim all 
system, and we have not as yet a sufficient 
number of observations on which to ground 
a theory: let us be contented, for the pre- 
sent, with consulting experience, and fol- 
lowing its indications. 

If it should so happen, that, from the 
draining of the marshes, the plague, and 
other diseases of that nature, should dis- 

( 174 ) 

appear, and the coast of Egypt, along the 
Mediterranean, should become as healthy 
as the rest of that fine country, this hospi- 
tal may then be appropriated to the recep- 
tion and cure of patients having the itch 
and venereal disease, as the chamber of 
reception would serve for a bath, and in 
that set apart for warm oily frictions might 
be performed the frictions proper in these 

After what I have set forth in this work, 
there could be nothing to be dreaded on 
the score of the contagion, which might be 
communicated to these fresh tenants; be-, 
sides an exposure to the air (une serine) of 
all effects for forty days, if judged requisite, 
would remove every danger and objection. 

Patients with dysentery, ophthalmy, and 
even those with wounds, might be also 
cured there, as they would be in no danger 
of hospital fever, or gangrene : the surgeons 
might perform their operations in the room 
set aside for frictions. A fter an engage- 
ment, either by sea or land, or in case of a 
debarkation of troops, if more space should 

( 175 ) 

be requisite, the great terrace which is 
above might be very soon converted into a 
ward, which would double the number of 
beds, and by placing those in the other 
wards a little closer, room might be made 
for three hundred provisional beds: and the 
same number of offices would be sufficient 
for this service. 

During the time of an epidemic, the 
bringing together so great a number of sick 
would be perfectly inadmissible, and the 
hospital should then be put into its former 

( 176 > 




Upon a Work written by M. Assalini, entitled, Observations 
upon the Disease called the Plague, &c Extracted from the 
Registers of the Society of the School of Medicine of Paris : 
the Sitting of the 14th Ventose, Year 9 (6th March, 1801). 

1 HE work which M. Assalini presents 
to the Society, under the title of Observa- 
tions on the Disease called' the Plague, &c. 
contains some remarks made by the author 
on the diseases which prevailed epidemically 
in the army of the East, both in Egypt 
and in Syria; upon some other diseases 
reputed contagious; the dysentery and the 
ophthalmy of Egypt; and the plan of an 
hospital proper for the treatment of the 
diseases which are epidemic in this colony. 

( 177 ) 

The intention of the author is to make 
known the facts to which he was witness. 
He has drawn a conclusion differing widely 
in many respects from the common opinion, 
particularly on the fact of contagion, as 
well as on the supposed cause of the disease 
known under the name of the plague. 

We shall just give a summary idea of the 
observations contained in this work. 

In the Introduction, M. Assalini men- 
tions the circumstances which might pos- 
sibly affect the health of the soldiers, after 
the epoch of their landing at Alexandria, 
The heat of the days, the cold damps of 
the nights, the exhalations of the marshy 
lakes, the quality of the food, the scarcity 
and want of water during their march across 
the desert plains, from Alexandria to Cairo, 
in the year 6, the imprudence of sleeping- 
out of quarters, or in the currents of air 
from open windows, comprise the whole 
of the causes to which the author attributes 
the greater part of the ophthalmies and 
dysenteries. He gives afterwards a short 
description of Jaffa (the ancient Joppa), 

( 178 ) 

of the lakes which surround it, and the 
miseries which the war brought together in 
that city, in the course of the year 7 (1799). 

In the meteorological table of the year 7 
(1799), at Cairo, we perceive the climate 
of Egypt characterized by a remarkable se- 
renity of sky, interrupted only in the month 
of Nivose (December, January) by some 
rains; and the whole year divided into six 
uninterrupted months of a clear serene sky, 
and into six other months of a sky covered 
with some clouds, among which are two: 
months of mists; namely, the months of 
Brumaire and Frimaire (October, Novem- 
ber, December). 

After these preliminary remarks, the au- 
thor treats of the diseases which afflicted 
the army of Egypt during the years 6 and 
7 (1798 and 1799). 

The principal is a disease which attacks 
several individuals at the same time; the 
chief symptoms of which are, fever, buboes, 
carbuncles, loss of strength, head-ach, and 
delirium ; which most frequently carries off 
the patient about the third or fifth day, and 

( 179 ) 

"which every year shows, itself more or less, 
along the coasts of the Mediterranean and 
the Archipelago, from Alexandria to Con- 
stantinople. It has been called the Plague i 
a dreadful name, because it conveys to 
the mind the combined ideas of an inevit- 
able contagion, and almost certain death. 
Hence, to avoid the fatal influence of a 
word to which so dreadful an appendage 
has been linked, the author calk the fevers 
which desolated the French army by the 
name of epidemic fevers. By others it has 
been called the fever with buboes. 

Among the characteristic symptoms of 
these fevers, the author especially remarked 
an uncommon apathy, in consequence of 
which the patient seeks out some solitary 
spot, where, covering his head, and giving 
himself up to sleep, he becomes totally in- 
different to the most powerful calls of in- 
terest; in which state he remains till seized 
with delirium : he dies on the third or fifth 
day after the attack. 

Here M. Assalini puts the query, whe- 
ther or not this disease be really contagious? 

( 180 ) 

The following are the facts on which he 
grounds his reply. 

Although a great many persons were at- 
tacked with the fever with buboes, after 
having had communication with the sick, 
there was a still greater number on whom 
this intercourse produced no such effect; 
and, on the other hand, many, in spite of 
the most complete shutting up, fell under 
its influence. 

The Egyptians, Syrians, and Turks, who 
communicated without any precaution with 
the sick, and shared the effects of those who 
died, did not contract the disease. 

The neglect with which the regulations of 
lazarettoes and the laws of quarantines, on 
the roads from Alexandria and Damietta to 
Cairo, were observed, did not occasion the 
disease to spread itself to the latter city. 

Into the hospital of Ibrahim Bey three 
patients were received, who died two days 
after of the disease ; yet, of sixty persons 
who were then in that hospital, not one 
caught the contagion. 

The physicians of the country, and Citi- 

( 181 ) 

zens Desgenettes and Larray, braved the 
contagion throughout : the first inoculated 
himself in the arms and groins, yet none of 
them were attacked with the disease. 

The author received on his hands the pus 
of buboes which he was laying open : he 
slept in sheets washed by a woman who 
died the next day of the disease ; a sick wo- 
man reposed herself on his bed, and died in 
like manner on the day after : yet he had 
no attack of the malady. 

In his inquiry into the causes which gave 
rise to the developing of this disease in the 
army of Syria, M. Assalini makes the fol- 
lowing reflections. 

The Turks made prisoners at El-Arish, 
and at Jaffa, could not have communicated 
the contagion, because they themselves were 
not affected with the disease. 

The division Kleber, at its departure from 
Damietta, was in very good health, in which 
state it continued while crossing the desert: 
the army then arrived free from contagion ; 
it could not, according to the author, meet 
with the germs of the disease, but in the fa- 

( 182 ) 

tigue, want of water, and scarcity of live 
stock in the desert, in the winds, the rains, 
and the inconstant weather, and difference 
of the climate of Syria from that of Egypt, 
in the topographical disposition of the en- 
campments around Jaffa, in the marshy 
waters of a lake in the neighbourhood of 
which was encamped that division of the 
army which was the first attacked, although 
it came direct from Cairo. 

Rosetta, Damietta, and Alexandria, sur- 
rounded by marshes, and of course exposed 
to the like influences, are subject to the 
same diseases. 

In Egypt the places elevated above the 
damp and infected vapours which fall down 
upon the plains, were constantly exempt 
from contagion. These vapours envelope 
the habitations of the lower country in a 
mist, which is very visible either at the 
rising or setting of the sun. Of the places 
which, on account of situation, are pro- 
tected from this scourge, the citadel of 
Cairo is quoted as one instance. Its inha- 
bitants, during the plague of 1791, were 

{ 183 } 

exempt from the disease, which laid waste 
the lower town, with which, nevertheless, 
they continued to hold constant intercourse. 
The author mentions other examples, pre- 
senting similar results. 

It is a known fact, that in the unhealthy- 
latitudes of Africa and America, one method 
not only of preserving from, but likewise of 
curing those affected with the diseases ende- 
mic in those places, even when threatened 
with approaching death, is the removing 
them to another situation. Often the wished- 
for effect is produced by the mere change of 
place, although perhaps the spot to which 
the journey is made does not afford superior 
advantages in point of healthiness.* 

M. Assalini observed the same fact in 
the Egyptian fevers with buboes. He cites 
a great many instances, from which he con- 
cludes, that no distinction ought to be 
drawn between the causes and phenomena 
of the production of fevers with buboes, 

* In America, however, it is m the removing from the coast 
to the interior of the country, that these fortunate changes ar& 
most remarked. 

( 184 ) 

and of those which desolate other countries, 
and which have never been suspected to be 
of a contagious type. Lastly, the author 
mentions an observation which he thinks 

During all the time that the English pre- 
vented the arrival of any vessel in Egypt, 
the disease raged in the army of the East. 
On the contrary, when the blockade was 
abandoned, and Tripolitan, Algerine, and 
other vessels were permitted to come in, the 
disease did not take place during that period. 

From all these observations, as might be 
expected, M. Assalini concludes, that the 
disease which attacked the army of the East 
in Egypt and Syria, and which, considered 
in its individual symptoms, bore a good 
deal the character of the disease known by 
the name of the plague, considered collec- 
tively, was evidently epidemic, and not truly 
contagious; and that it was occasioned by 
Jocal causes, and not by a germ brought 
from abroad. 

After these reflections, M. Assalini pro- 
ceeds to the consideration of the treat- 

( 185 ) 

ment. He reduces it to three indications : 
to diminish plethora when it exists, to 
empty the primae via? when they are loaded, 
and to excite perspiration and sweating. 
As the two first indications are only condi- 
tional, it is evident that the third is that 
which he considers as essential and funda- 

We shall not follow him through the de- 
tails, but will only remark, that one of the 
means of which he speaks most favourably, 
either as a preservative, or as useful in the 
treatment, is the use of coffee without sugar, 
mixed with citron juice, and given by cup- 
fuls five or six times a day. He treats pretty 
fully on oily frictions, which have been for 
some time celebrated, and appears to place. 
a good deal of confidence in them. In 
"•eneral, the tonic and sudorific treatment 

o * 

followed by Citizens Desgenettes and Lar- 
ray in Syria, Dieche near Acre, Savaresi at 
Damietta, Sotira at Rosetta, Ghisleni and 
Balbes at Alexandria, constantly saved, he 
says, two thirds of the sick, the greater part 
affected with buboes. 


( 186 ) 

As to the particular treatment of the car- 
buncles and buboes, M. Assalini condemns 
the practice of opening or burning them 
with the actual cautery, before they come 
to maturity. He recommends the use of 
cinchona internally, externally anointing the 
tumours with oil 5 and he thinks that they 
should be opened whenever symptoms of 
suppuration have appeared. 

The particular precautions which M. 
Assalini made use of for his own preserva- 
tion, consisted merely in avoiding as much as 
possible remaining in the unhealthy places, 
making use of the best food he could pro- 
cure, and keeping himself constantly em- 
ployed, in order to avoid low spirits. He 
took care to arrive at the hospital without 
being in a sweat ; before going his round, 
he drank a large cupful of bitter coffee; on 
leaving the hospital, he rode out on horse- 
back, till he brought on sweating; and, 
before going to bed, he took a cupful of 
punch quite hot, which made him perspire 
profusely during the night. As to the rest, 
he took no precautions against the contact 

( 187 ) 

of the infected, except avoiding the direct 
impression of their breath. 

With regard to general precautions, one 
of the principal which he recommends, to- 
support which he quotes a number of facts s 
and on which he relies, with most confi- 
dence, is the moving the troops, and suc- 
cessively changing the garrisons from one 
quarter to another. Lastly, measures of 
police for keeping the streets clean, and in 
good order, the necessity of paving them, 
and of draining the morasses by canals, and 
filling them up to prevent the stagnation of 
the waters, are precautions, the importance 
of which appears to him evident, on consi- 
dering the present state of the environs of 
Damietta, Rosetta, Alexandria, and the 
fort of Birket-El-Hadji, and which, con- 
jointly with the restoring and bringing to 
perfection the art of agriculture, appear to 
him necessary, in order to place Egypt in 
that state of salubrity which it undoubtedly 
enjoyed in the time of its ancient prosperity. 
May his wishes be accomplished : may 
the beginning of this century witness the 

( 188 ) 

complete extermination of two of the most 
dreadful scourges of humanity, the small- 
pox and the plague ! 

After these different observations, the 
author gives an account of the customs 
followed by the Franks or the Europeans 
in the Levant, the precautions used in la- 
zarettoes, and the laws of quarantines. The 
particulars of this department of the public 
police are sufficiently known. But possibly 
some concern may be felt on seeing in what 
an unfavourable light the author views 
these establishments, from his comparing 
together the deplorable effects resulting 
from terror and shuttings up during the 
European plagues, and the less fatal effects, 
as he says, of the unconcern of the Mus- 
sulmen; an indifference which at least 
prevents them from being deaf to the calls 
of their friends and relations, who, on their 
death-bed, implore their assistance. How- 
ever true the author's reflections may be, 
his intention can never be to authorize the 
national gratitude to be withheld from the 
patriotism of those citizens who have esta- 

( 189 ) 

blished and supported, to the present time, 
the lazaretto of Marseilles, and who, dur- 
ing twenty-four years, have been the senti- 
nels of France, for the purpose of preserv- 
ing the public health. 

M. Assalini next says a few words on 
the disease which, in the year 8 (1799- 
1800), attacked the army of Italy in the 
Ligurian Republic. It was of the nature 
of the jail fever, and was not at all conta- 
gious. He adds some reflections on the 
yellow fever of Cadiz. The several ques- 
tions which he puts on this point, the 
doubts which he starts on the degree of 
mortality caused by that disease, and on its 
spreading by contagion, can only be re- 
solved and removed by an exact knowledge 
of the facts. 

The dysentery, to which he was witness 
in Egypt, appears to him uniformly to arise 
from the suppression of perspiration, owing 
to the imprudence with which the soldiers 
exposed themselves, by sleeping in the cold 
and damp night air. He distinguishes it 
into three, degrees: the first consisting of 

( 190 ) 

simple dysentery, without colic; the second 
accompanied by colic and mucous evacua- 
tions; and the third accompanied by fever, 
bilious, putrid, and bloody evacuations. 
In the treatment, varied according to the 
indications and circumstances, the author 
mentions the advantages obtained by means 
of opium, the utility, in certain cases, of 
blisters applied to the abdomen, and of 
the fruit called bao-bab, or monkey's bread 
( Adansonia bao-bab), much recommended 
by the native physicians. He recommends 
the practice of adding a little coffee, or 
brandy, to the Nile water, as a preserva- 
tive against this disease. 

Lastly, the ophthalmy, divided by the 
author into the simple and the complicated, 
that is to say, with swelling of the con- 
junctiva and palpebral, violent pains and 
fever, and various organic lesions of the 
ball of the eye — the ophthalmy appeared 
to M. Assalini constantly produced by the 
influence of the cold night air, joined to 
the fatiguing effect of the burning heat 
and excessive light of the sun on the organ 

( 191 ) 

of sight. The sands driven by the winds, 
and the saline substances with which they 
are impregnated, appeared to him to be 
only accessory influences, which may pos- 
sibly aggravate the effects, but which are 
subordinate to the principal cause: in short, 
that this disease, and the dysentery, in his 
opinion, only differ from each other in the 
-part affected, and are especially determined 
in proportion as the one or the other be- 
comes most irritated or enfeebled. 

The treatment of the ophthalmy presents 
nothing: new. He reduces it to the em- 
ploying of means to produce revulsion, and 
of tonic and astringent collyriums, not for- 
getting to follow the indications presented 
by the several consecutive organic lesions. 
The remedies of the country are of little 
value, and the precautions for preventing 
the attack consist in being careful not to 
sleep in the open air, but particularly in 
the current of air from open windows ; and 
when on duty in the field, to keep the head 
covered, and protected with a cloak. 

M.Assalini concludes his work with the 

( 192 ) 

plan of an hospital adapted to the country. 
It consists of a large building, the fronts 
look to the east and west, and the windows 
extend from the ceiling to the floor. The 
ends looking to the south and north are 
easily shut against these winds, so danger- 
ous in that country. There are likewise 
rooms adapted for stoves, oily frictions, for 
the reception of convalescents, and for 
other purposes. A wind-dial (rose de vents ) y 
communicating with a weather-cock, is 
placed in the ward, in order that the phy- 
sician may regulate the opening and shut- 
ting the windows, and ventilating the wards 
according to the weather. The building 
is terminated at top by an open terrace, 
adapted for a promenade during the time 
of the epidemic. There are likewise seve- 
ral other arrangements, well adapted to 
the necessary purposes of such a building. 
Such is the concise idea which we have 
thought fit to give here of M. Assalini's 
work. It remains for experience to decide 
the queries therein discussed on the subject 
of contagion j queries on which immediately 

( 193 ) 

depends the theory of the preservative 
means, and of those proposed for the destroy- 
ing the source of the pestilence. However 
strong his reasoning may appear, before pro- 
nouncing judgment it behoves us to wait 
until the united observations of all those 
physicians who have observed the same phe- 
nomena as himself upon the same theatre, 
and at the same time, shall begin to dissipate 
our doubts, and to teach us whether or not 
the ancient opinions, consecrated by time, 
and the authority of the greatest names, 
ought to be ranked amongst those preju- 
dices which time destroys so slowly, but 
which the lights of philosophy and science 
ought at length to overturn. 

In supposing the decision perfectly con- 
formable to the observations of M. Assa- 
lini, and to the conclusions which he draws 
from them, there will still remain on the 
phenomenon of contagion, a great num- 
ber of other questions to be resolved : and 
when we not only consider the diversity of 
opinion amongst the observers, but when 
we compare the facts with each other, and, 

{ 194 ) 

at the same time, consider the phenomena 
of contagion in those diseases in which this 
property exists beyond a doubt, it may be 
asked, whether it may not be possible to 
imagine that the same disease mav not be 
more or less contagious, or even not at afl 
so, according to circumstances, such as the 
violence of the epidemic, the state of the 
intervals of the contagion, and the particu- 
lar predispositions of those individuals who 
are attacked with it; predispositions which 
may have something both of an epidemic 
and also endemic tendency ; so that a dis- 
ease exactly the same in its characteristic 
symptoms, shall perhaps have been re- 
marked at different times, and in different 
places, to be contagious or non-contagious, 
hy observers of equal accuracy and infor- 
mation? This is not a question of simple 
theory, or of pure curiosity. 

In pursuing this inquiry, the physician 
ought, without doubt, to be cool, and un- 
biassed by prejudice, or any foreign consi- 
deration; but he should also be persuaded 
of this very important truth, that if it be 

( HW ) 

useful in such cases to inspire individuals 
with confidence, it is no less important not 
to lull into a false security the solicitude of 

Nevertheless, the work of M. Assalini 
appears to us to be important in its object; 
valuable from the collection of facts which 
it presents us, useful and judicious from the 
manner in which they are compared and 
discussed; and, without prejudging its ul- 
timate consequences, we think that it may 
contribute to diffuse information on a sub- 
ject become more interesting than ever, and 
which is thus submitted to the meditations 
of observers, and the attention of govern- 

(Signed) Thouret and Halle, 


A true Copy, in the name of the Committee 
of Administration of the School of Medi- 
cine, the 24rth Ventose, in the year 9. 

(Signed) Thouret, Director. 

196 ) 


Made to the Consuls of the French Republic, 
by the Minister of War, the 15 Germinal, 
Year 9 (Uh April, \%Q\.) 

1 HE Minister of War has received such 
important details on the state of the hos- 
pitals of the army of the East, that he thinks 
it proper to submit the result to the inspec- 
tion of the Consuls. 

In Europe, during the war, the number 
of sick was to that of effective men as one to 
twelve; and before the revolution, during 
peace, the proportion was the same. In 
Egypt it has been, during the month of 
Brumaire (October and November), as one 
to twenty-eight; and during Frimaire (No- 
vember, December), as one to thirty 

In Europe, in the military hospitals, the 
number of deaths is to that of sick admitted 

( 19*7 ) 

during the month, as one to twenty-three. 
In Egypt, during the month of Brumaire, 
the proportion has commonly been as one 
to forty-three ; and in Frimaire, as one to 

The increase of deaths during this last 
month was owing to the contagious dis- 
ease which, though little spread, was be- 
ginning to show itself. 

It is known that in Europe the number 
of sick is to the population as one to twenty, 
and that in a month the mortality is to the 
number of sick as one to nineteen ; so 
that the best established facts prove, that 
the climate of Egypt is already become to 
Frenchmen more healthy than their native 
country, or than any other country in Eu- 
rope : what then will it be when the sci- 
ences and arts shall have diffused all their 
advantages, and shall have banished from 
it its contagious diseases, and instructed us 
in the means of preventing the ophthalmy ? 

By making for those two months the 
number of daily reports of the sick in the 
hospitals of the army of the East equal to 

( 198 ) 

unity, we find that the daily reports have 


For febrile diseases - - 0.393 

Wounded - - 0.187 

Venereal - - 0.369 

Contagious disease - 0.007 

The ophthalmy - 0.044 


You perceive, Citizen Consuls, the re- 
markable salubrity of this fine country, for- 
merly the cradle of the arts and sciences, 
which was the granary of Rome, which 
ought to be the emporium of commerce 
between India and Europe, and which is 
one of the theatres on which have been 
most signally displayed the spirit and bra- 
very of Frenchmen. 

(Signed,) Alex. Berthier, 

i 199 X 


Page 71, line 11. 

ClTIZEN CERRESOLI, physician -of the army of 
the East, in his journey from Cairo to Siout, speak* 
ing of the plague, says, that he never has been able 
to collect the information he wished for respecting 
this disease ; but, after a great many accounts, he 
concludes, that the word plague, or koubeh in Arabic, 
is a generic denomination applied to acute and ma- 
lignant diseases.. 

Page 72, line the last. 

It is commonly asserted that the heat in Egypt 
puts a stop to the progress of the plague, whilst it 
makes it burst out at Constantinople. How is this 
fact to be accounted for ? The explanation is, in 
my opinion, very simple. At Constantinople the 
exhalations from various bodies in a state of putre- 
faction are very copious during summer: the cold 
«f winter prevents their, formation; and the disease 

( 200 ) 

ceases. In Egypt, on the contrary, the action of 
the sun is very powerful, even during winter, and 
gives rise to noxious exhalations, as we have proved 
elsewhere. When the. low grounds have become 
dry, which happens about the month of Messidor 
(in June, at the festival of St. John), then the coast 
of Lower Egypt becomes as healthy as the rest of 
that fine country. 

The environs of Modena were formerly subject 
to a class of diseases, which Torti has with justice 
denominated malignant fevers, because they frequently 
carried off the patient during the third paroxysm, 
and even when considered out of danger. Debility, 
drowsiness, and excruciating head-ach, were the 
principal symptoms of these fevers ; between which 
and those of Egypt there exists a strong resemblance. 
At this day the malignant fevers of Torti have either 
disappeared altogether, or are become very rare. 
This change has been attributed to the filling up of 
the ditches and morasses which surround the city 
and citadel of Modena, the corrupting waters of 
which occasioned exhalations which infected the air. 
The celebrated Torti has taught us the mode of 
curing this disease as if by enchantment, by means 
of Peruvian bark, given in large doses, frequently 

I had an opportunity of seeing and treating this 
disease near Mantua: its course is so rapid, and its 
symptoms so violent, that in order to stop its pro- 
gress I was always obliged to give three ounces of 

( 201 ) 

bark, mixed with wine or water, in the course oi 
twenty-four hours, between one paroxysm and ano- 
ther; and when the patient was weak, I did not 
omit adding more or less of liquid laudanum* ac- 
cording to their state of constitution. 

Those physicians who, from a dread that this 
practice will overheat, or cause obstruction, prefer 
the use of refrigerants, or purgatives, in order to 
evacuate the bile, have constantly the mortification 
©f seeing their patients carried off as if apoplectic, 
and in a very short time ; and if they escape, after 
suffering from fever for several months, they at 
length become dropsical, which they never fail to 
attribute to the bark, which they were too late in 
prescribing. Practitioners of experience, who treat 
this disease successfully, according to Torti's me- 
thod, agree, that these diseases may be cured with 
bark of a good quality, but not with powdered oak- 
bark, such a was furnished at one time to the mili- 
tary hospitals of the army of Italy ; which was the 
real cause of the loss of many brave men, and of the 
disease frequently terminating in obstinate obstruc- 
tions. The physicians and apothecaries who did 
duty in the different hospitals for febrile diseases at 
Milan can attest the truth of this fact. 

Page 109, line the last. 

Change of place and air was often useful in the 
^nost obstinate cases of dysentery. 

( 202 ) 

Citizens Livron, Pagliano, and Corance, attacked 
with a diarrhoea which would not give way to all the 
remedies which Citizen Desgenettes and myself had 
prescribed them, very soon recovered by removing 
from Cairo to Alexandria. A great many persons 
who had the dysentery very severely at Alexandria, 
got well by removing to Cairo. I remember Gene- 
ral Bessiere, who now commands the cavalry of the 
Consular Guards at Paris, so ill and pulled down at 
Cairo, that his life was thought in danger : he re- 
covered in a very short time at Giseh. 

Page 1 13, line 24. 

The hab-hab is the fruit of the bao-bab, or baho-bab } 
a tree of a monstrous size, which grows in Ethiopia 
and Senegal: by the natives of this island it is called 
goui, and its fruit boui; by the French callebassier, or 
gourd-tree, and its fruit pain de singe, or the monkey- 
bread. Adanson, after returning from Senegal, com- 
municated, in the year 1761, some very curious and 
interesting particulars respecting this tree, and its 
medical properties, to the Royal Academy of Sci- 
ences at Paris. As these are a good deal connected 
with the subject I have been just treating, it may not 
be amiss to give here the following particulars. 

The bao-bab, on a near view, looks more like a 
forest than a single tree. Its trunk is seldom more 
than ten or twelve feet high, but its circumference 
is generally from seventy-fiye to seventy-six feet and 

( 203 ) 

a half. This immense trunk is crowned by a great 
number of branches, remarkable on account of their 
size, but still more on account of their length, which 
varies from fifty to sixty feet. That branch which 
springs from its centre rises vertically, but those 
from its sides have generally a horizontal direction* 
These trees commonly have a great many roots, 
almost as large and numerous as their branches, but 
of a still greater length. Adanson saw one which 
measured one hundred and sixty feet long : it be- 
longed to a tree of the middling size. 

The leaves of the bao-bab are elliptical, pointed 
at the extremities, about five inches long, and one 
or two inches broad, of a moderate thickness, glossy, 
entire, having no serrated edges, the upper surface 
of a bright green, the under surface of a pale green 
colour, crossed obliquely by alternate nerves, rounded 
off, little elevated, and attached from three to seven 
together, upon a common foot stalk like a fan, pre- 
cisely like the horse-chesnut. 

The flowers of this tree, when in bud, form a 
globe of almost three inches in diameter ; and on 
blowing become four inches in length, and one in 
breadth: two or three spring out from every branch, 
each suspended by a cylindrical peduncle, a foot 
long, and five lines thick. The -calix of each of 
these flowers is of a single piece, in the shape of a 
saucer, the edges of which are divided into five 
equal triangular portions: it is entirely covered with 
hairs of a whitish colour, and shining on the upper 

( 204 ) 

surface, and green on the under surface; it falls off 
as soon as the fruit is set. The petals are five 
in number, within which arises a hollow cylinder, 
crowned with about seven hundred stamens, in the 
form of a ring, the filaments of which have on their 
summit small anthers, which, on bursting, throw 
out a whitish pollen. From the centre of the calix 
arises the pistil, the length of which a little exceeds 
that of the petals; it is composed of three parts, 
namely, an ovary, a style, and several stigmas. The 
ovary is egg-shaped, ending in a point, and entirely 
covered by thick shining hairs ; its summit supports 
a very long cylindrical style, a little bent, hollow in- 
ternally, and crowned by ten or fourteen prismatic 
triangular bodies, pretty large and shaggy, called 
stigmas. The ovary of the flower of the bao-bab, 
on ripening, becomes a considerable fruit, of an egg- 
like shape, pointed at both ends, about a foot or a 
foot and a half long, and from four to six inches 
thick, suspended by a cylindrical peduncle, about 
two feet long, and more than one inch in diameter; 
its rind is woody, very hard, two or three lines thick, 
and covered externally with a down composed of 
green hairs, which give it that colour. On rubbing 
off this down, it appears blackish, and strongly 
marked by ten or fourteen furrows, which run along 
its whole length like so many rays.: when we cut 
this fruit through, we discover in it ten or fourteen 
membranous partitions, of a reddish colour, and 
stringy texture, which divide it longitudinally from 

( 203 ) 

top to bottom into as many cells, which are com- 
pletely filled with seeds : these partitions are attached 
to the inner walls of the woody rind, and are joined 
together at the centre of the fruit, as round a com- 
mon axis, as long as it preserves its first moisture ; 
but, on becoming dry, they separate widely apart, 
leaving a hollow at the centre. In this dry state 
they resemble a good deal, both in substance and 
shape, that part of the dura mater called the falx. 
The seeds, on opening the fruit, do not appear dis- 
tinct ; nothing is at first seen but a spongy substance, 
which is whitish in the sound fruits, and reddish in 
those which are ill formed, or very old. When the 
fruit is first ripe, this substance forms but one mass, 
on account of the moisture which it still possesses ; 
but on drying it becomes friable, and separates either 
of itself, or on the smallest shake, into a great many 
irregular polygons, each of which contains a blackish 
brown seed, glossy, kidney-shaped, about five lines 
long, and three lines thick, from the sinuosity of 
which arises a cord, or reddish filament, very long, 
which is attached horizontally, as to a placenta, 
into the inner edge of the partitions at the centre of 
the fruit. 

This tree sheds its leaves in the month of Novem- 
ber, and puts them forth anew in June, flowers in 
July, and in the months of October and November 
its fruits are quite ripe. 

With regard to the medical virtues of this tree, 
Adanson says, that the natives of Senegal dry the 

( 206 ) 

leaves in the shade, and then reduce them to pow- 
der, whieh powder they call lalo : they put two or 
three pinches of this into their food, in order to 
moderate the excessive heat of their blood, and keep 
up a plentiful perspiration, which preserves them in 
good health. 

Adanson asserts, that he himself was preserved 
from the fevers which he calls ardent, and which 
spread epidemically, attacking the natives of Senegal, 
and especially the Europeans, whom they carry oft* 
in great numbers, during the months of September 
and October; that is to say, on the sudden ceasing 
of the rains, when the sun begins to dry up the pools 
of water which are left on the ground. At this dan- 
gerous season Adanson made a weak tisan from the 
leaves of the bao-bab: this tisan is tasteless : when 
it is made very strong, it discovers a faint taste, 
which is easily corrected by adding a litttle sugar, 
or a little liquorice root. Every year, during these 
two months only, he took half a pint of this decoc^ 
tion in the morning, and the same quantity in the 
evening after the great heat. He likewise took it 
towards the middle of the day ; but that was only 
when he felt some degree of head-ach, indicating the 
attack of fever. By this means he prevented, during 
a residence of five years in Senegal, the diarrhoeas 
and ardent fevers, which are almost the only diseases 
to be dreaded in that country. To display more 
strikingly the good effects of this tisan, taken during 
the critical season, he relates the following fact : 

( 207 ) 

<« In the month of September, 1751, when the ardent 
fevers were raging more than had been remembered 
for several years past in Senegal, I continued," says 
Adanson, " my fatiguing excursions a hunting and 
botanising, with as much eagerness as I could have 
done at home ; and one of my friends who followed 
my example in using the tisan, was the only one 
besides myself who pursued his usual occupations, 
whilst all the other French officers were confined to 
bed, a circumstance which surprised them much, 
particularly as to my friend, whose very delicate 
constitution appeared more susceptible of the im- 
pressions of bad air, which was believed to be the 
chief cause of the epidemic diseases of this season. 
A remedy so innocent, so simple, and from which t 
experienced such good effects, ought to be employed 
during this season, to prevent not only these burning 
fevers, but also the ardor urinx, which is very com- 
mon during the sickly season ; that is to say, from 
the month of July till the month of November. Ex- 
perience has convinced me, that this tisan alone is 
sufficient, provided wine is abstained from." 

The fruit of the bao-bab is of no less use than the 
leaves we have just mentioned ; they eat the fungous 
pulp surrounding the seeds ; it has a sourish taste, 
rather pleasant, particularly in the fruits of that year, 
which are still in some degree fresh. In time this 
fruit loses considerably in its good qualities; never- 
theless, it is exported from Senegal to the neigh- 

( 208 ) 

bouring nations in the kingdom of Morocco, and in 

Prosper Alpinus says, that this fruit is brought to 
Cairo in so dry a state, that its pulp can be reduced 
into a powder, which is there called earth of Lemnos. 
It is generally used in pestilential fevers, in spittings 
of blood, the lientery, dysentery, and hepatirrhcea : 
it is likewise used to moderate the menstrual dis- 
charge. The dose of this powder passed through 
a fine sieve, is one drachm : the physicians prescribe 
it for the sick above-mentioned, and make them take 
it either in solution in the plantain water, or in in- 
fusion or decoction in common water. Prosper Al- 
pinus is the first botanist who has mentioned this 
tree, and he has given the following description of 
its fruit: c> 

" Bao-bab est fructus magnitudine mali citri, cu- 
curbits similis, intus semina nigra, dura, extremis 
in unum seminarium quasi inclinantibus, et substan- 
tiam cucurbitarum similem habent, qux in recenti- 
bus est humida, rubra, sapore acido non ingrato 
fructus recenter ab arbore exscissus, gustui admo- 
dum gratus est : valentes extinguit multumque re- 
frigerat, febresque omnes putridas, prsecipueque pes- 
tilentes sanat. Cairi habitatores fructum in pulve- 
rem reddunt, qu:e terra Lemnos appellatur ; estque 
apud multos familiarissimus illius ce terras usus ad 
pestiferas febres, turn ad sputum sanguinis, ad lien- 
terias, dysenteriam, cruentumque hepaticumfluorero, 

( 209 ) 

necnon ad uteri menses firmandos. Alii hujusce 
terra; in subtilissimum pulverem redacts drachmam 
cum aqua plantaginis dissolutam exhibent, alii de- 
cocto, alii infuso utentis." See Alpinus Des Plantis 

In the Jardin des Plantes at Paris there are seve- 
ral specimens of the fruit of the bao-bab, in very 
good preservation. The celebrated Jussieu pointed 
out to me a covering on the outside of the green 
down, which I had never observed in Egypt: the 
taste of the pulp of this fruit was not at all different 
from that of the powder of Lemnos, which I had 
tasted at Cairo, and used in the cure of the dysen- 

Citizen Frank, physician of the army of the East, a 
person well known in the republic of letters, was bu- 
sily engaged while I was at Cairo, in a work on the 
Materia Medica of the Egyptians, in which he pro- 
poses giving some interesting particulars on the use 
of the fruit of the bao-bab, and of several other plants 
brought into Egypt from the interior of Africa. It is 
to be wished that travellers in foreign countries 
would imitate the inhabitants of Africa, who are in 
the habit of carrying constantly with them the seeds 
of fruits, of pulse, and of those trees of which they 
make constant use ; and it is from this circumstance 
that several plants from Africa have been trans- 
ported to America, where, at this time, they have 
become so multiplied, that they appear natural to 

these different colonies. 


( 210 ) 

Page 131, line the last. 

Citizen Lazowski, chief of a brigade of engineers, 
who has lately returned to France, assured me, that 
he had been attacked with ophthalmy in Egypt four 
different times, and always during the height of the 
inundations of the Nile, and in those places where 
there was neither sand nor dust. He went one even- 
ing to sail in a boat on the place Lisbekir, in order to 
assist at an artificial fire-work on the water ; he was 
immediately attacked with the most violent and ob- 
stinate ophthalmy. This distinguished officer also 
told me, that he had travelled across the desert four 
times, and had remained during a month at El-Arish, 
encamped amongst the sands, which were often 
blown by whirlwinds into the camp, without his 
having ever experienced an attack of ophthalmy. 

The troops in garrison at Kene, and those on the 
ports on the Nile, in Upper Egypt, had almost all the 
disorder in their eyes during the time of the inun- 
dation, and got well on going to relieve the garrison 
of Cocyra, a port on the Red Sea, although they had 
to travel across twenty-four leagues of desert. They 
attributed their cure to the waters oiBiranba^ a foun- 
tain which they met with on their route. This water 
is whitish, and of a strong cathartic quality. 

( 211 ) 


The following Article is taken from " Notes on the 
West-Indies; written during the Expedition under 
the Command of the late General Sir Ralph Aber- 
cromby, £s?c. By George Pinckard, M. D. of the 
Royal College of Physicians? £s?c. In three Va- 
lames, published in London in 1806. 


JTxS you express a strong interest regarding the 
malady which has committed such afflicting ravages 
in our army, and desire to have a letter devoted 
exclusively to the subject, I now proceed to lay be- 
fore you a summar}', which, although it may not 
afford you any additional information, may serve 
as a recapitulation of what has been already trans- 
mitted to you, from time to time, in my frequent 
communications. I shall confine myself principally 
to what concerns the nature of the disease, feeling 
that a minute detail of the symptoms, and mode of 
treatment, would not only be less interesting, but 
perhaps very tedious to } r ou. 

( 212 ) 

After all that I have been able to observe, with 
respect to this dread complaint, I think that, re- 
garding it as a malady of the West-India colonies, 
it may, correctly, be said to be the effect of climate 
operating upon exotic bodies. It is the fever of 
the country — an endemial malady, which attacks 
those most severely whose general vigour, and 
whose firmness, or density of fibre, offer the strong- 
est resistance. To look for it in ships and vessels, 
or to strain the eye across the ocean, in order to fix 
its birth-place upon the opposite coast of the Atlan- 
tic, or to trace its descent from the shores of the 
Indian seas, were to overlook the reality in search 
of a phantom. — It needs no foreign parent : the 
prolific earth is its mother — its father the bright 
God who governs the day. 

When Europeans first take up their residence in 
the West-Indies, it is usual for them, sooner or 
later after their arrival, to undergo an attack of 
fever, which, in times of peace and tranquillity, 
when, as they are called, the " nerv comers''' are but 
few, is termed a " seasotiing-fever'''— but, in times 
of war, when, from great multitudes arriving at the 
same period, its destructive effects are more strik- 
ing, is baptized with the terrific name of — " yelloxo 
fever:- — but, whether denominated seasoning, yelloiv, 
Bidam, or Siam, or marked by any other appella- 
tion, it is only the common bilious fever of hot cli- 
mates : and it appears under an intermittent, a re- 
mittent, or a continued form, according to the soil 

( 213 ) 

and situation of the place ; or the habit of the body, 
and other circumstances of the person attacked. 
In negros and Creoles it is frequently an ague — in 
those who are in a degree acclimates a remittent — 
and in nexv-comers a continued, or, as it is commonly 
termed, a yellow fever — preserving, in each case, 
a distinct type throughout its course ; while, in 
other instances of its attack upon Europeans, it 
shifts its form, and runs its progress with the most 
uncertain irregularity : in proof of which I may re- 
mark that it has happened to myself to receive 
newly-arrived soldiers into the hospital, at one and 
the same time, with this seasoning malady, under 
all the varieties of its intermittent, remittent, and 
continued form ; and, although each has been differ- 
ently attacked, all of them have died, in the course 
of only a few days, with every symptom of the most 
malignant yellow fever. 

Nature, in her all-preserving care, hath endowed 
the human frame with the power of accommodating 
itself to all the various climates upon the habitable 
regions of our globe ; yet hath she more expressly 
adapted our organs to the particular climate in 
which she hath stationed us : so constituting the 
nice and delicate movements of the animal machine, 
that we cannot, without peril, expose ourselves to 
sudden or violent transitions. 

To the inhabitants of different regions is given a 
something of constitutional difference, which it were 
difficult precisely to define : but it belongs to a cer* 

( 214 ) 

tain original conformation, creating a difference of 
fibre or stamina, which more particularly befits the 
body for the specific region in which it is designed 
to move. Yet, while much is attributed to our pa- 
rent nature, it ought not to be forgotten that habit 
is our foster-mother, and that she follows nature 
very closely in her influence upon the human frame ; 
and hence it is that by long residence, and similarity 
of pursuit, so near an approach to this specific and 
original structure may be acquired, as to promote 
healthy action in a being removed to a foreign, and 
even to an ungenial climate : still, this is only the 
yielding of a body originally different ; for the as- 
similation is never so complete as to be in all re- 
spects the same. The constitution of a negro from 
Africa, or the West-Indies, never becomes entirely 
British, although he reside in England the greater 
pari of hia days : and However much an European, 
by long residence in the West-Indies, be brought 
to resemble a Creole, he can never acquire, pre- 
cisely, the constitution of a native : some marks of 
original conformation will still remain, and a some- 
thing even in his general appearance, to distinguish 

Nor is this difference of organization confined to 
the human subject : other animal bodies, and also 
vegetables, differ in their structure and external ap- 
pearance, in different climates. The wool of sheep, 
removed from a northern region to the West- Indies, 
becomes hair: and the almost tasteless potatoe of 

( 215 ) 

Europe assumes a strong saccharine flavour from 
tropical culture. 

The influence of the atmosphere, not only in dif- 
ferent climates, but under its various changes in 
the same climate, is, at all moments, and in all coun- 
tries, far greater than common opinion supposes : 
nor has the attention of medical men been suffi- 
ciendy directed to this circumstance, although it is 
of great magnitude. Hypochondriacs, persons sub- 
ject to rheumatism, or asthma, and those afflicted 
with painful thickenings of the cuticle (usually 
termed corns), become exquisitely sensible of the 
slightest variations in the state of the atmosphere ; 
and from hence it may be concluded, that it cannot 
but operate, at all moments, with a powerful effect 
upon the tender fibres of our delicately organized 
vessels; and if in our native region the influence 
be so considerable, how infinitely important must 
it be when the body is exposed to the stronger im- 
pressions of an unnatural climate 

" , where the sun, with downward torrid ray, 

Kills with the barb'rous glories of the day." 

Without entering more minutely into the subject, 
which might swell my letter into a volume, suffice 
it to remark, that there appears to be a certain gra- 
dation in the tone, or firmness of the animal fibre, 
as we proceed from the hotter through the more 
temperate regions ; not following in exact mathe- 

C 216 ) 

matical proportion, but sufficiently manifest to form 
some standard for general observation ; and, per- 
haps, sufficient to sanction the assumption that the 
density or laxity of the human fibre bears an inti- 
mate alliance with the temperature of the climate, 
with respect to heat or cold, although it may be 
influenced, likewise, in no inconsiderable degree, 
by other circumstances; such as the dryness or 
moisture of the atmosphere, the state of the soil, 
the manner of clothing, and the habits pursued. 
In the colder regions towards the poles, the fibre is 
firmer, the circulation of the fluids slower, and the 
secretions more languid ; while in the warmer re- 
gions, near the equator, the fibre is lax, respiration 
quicker, the circulation more rapid, and the secre- 
tions more copious, and more speedily performed. 
In order, therefore, to fit the constitution of a polar 
inhabitant for a tropical climate, or to accommodate 
the system of a tropical inhabitant to a polar atmos- 
phere, it is needful that the change should be gra- 
dual, that the necessary density or laxity be induc- 
ed, with as little risk as possible of disorganiza- 
tion, and consequent dissolution.* It not only 

* It is probable that our troops might be rendered nearly as 
effective for service in the West-Indies as in Europe, were it 
possible, in all cases, to prepare them for the climate by slow 
and gradual approaches ; as for instance, bj first letting them 
serve, for a time, at Gibraltar, and afterwards employing them, 
for a year or two, in the more windward islands, such as Bar- 
badoes or Antigua, before they were sent upon duty to the 
other eclonies. 

( 217 ) 

happens that the inhabitants of cold climates suffer, 
on being transferred to the tropical regions — the 
negroes can as ill support the change to a northern 
atmosphere, and accordingly they are frequently 
the victims of being brought to Europe; for, amidst 
the cold of our winter, all their energies seem to 
be destroyed, and their faculties benumbed. They 
seldom live to old age, but, commonly, sink into 
marasmus, or are cut off by early consumption. 

Fever, excessive heat, violent passion, or any 
other cause which greatly, and suddenly hurries 
the circulation of the fluids, diminishes the tone 
and energy of the living animal fibre, and deprives 
it of that degree of firmness which is necessary to 
health; but, by gradually habituating the body to 
the change, a high degree of increased circulation, 
or a considerable diminution of the original density 
of fibre may be supported, without any consequent 
derangement of structure — the increased action of 
the vessels, the augmented velocity of .he fluids, 
and the subsequent laxity of fibre, induced by great 
heat, or high fever, may be borne, provided they 
are not so sudden, nor long continued, as to c ausc 

We have many familiar examples which testify 
the effect of original conformation, and the power- 
ful influence of habit upon the animal body, with 
respect to its state of health or disease. If a per- 
son accustomed to live in the gloom of London 
should expose his face, for only a short time, to 

( 218 ) 

«the full rays of a Brighton sun, the skin would be 
separated as if by the application of a blister ; but 
if a hardy shepherd of the downs were to lie upon 
the hills, with his face open to the broad sun 
throughout the whole day, not the smallest part of 
the cuticle would be disturbed. 

A negro, to whom the climate is congenial, can 
sun over the hills in the West-Indies, for many 
hours together, without suffering the slightest in- 
convenience; but if an European of more unyield- 
ing fibre, and but lately arrived within the tropics, 
were to follow him in such a course, it would be 
snore than probable — it would be almost certain, 
that, within a few succeeding hours, a fever would 
complete the disorganization, and send him to the 

So, the fluids of a racer may be hurried violently 
through his vessels, without any injury to the natu- 
ral organization : but if an unpractised horse, of a 
different original conformation, were to be taken 
from die cart, and made to gallop, with all possible 
speed, over a course of four or six miles, it is pro- 
bable that from the increased impulse, and the re- 
sistance of his unaccommodating fibre, fever, dis- 
organization, and death would speedily ensue. 

In cold or temperate climates, bulls are baited, 
and hares hunted, in order that the sound texture 
ef their fibres may be broken down, and the mus- 
cles made tender, by their dying in the fever of in- 
leased and violent circulation. — This is a fact so 

( 219 J 

well known to all sportsmen, that a hunted hare is: 
always preferred to one that has been shot, or taken 
by other means. 

Epicures let their meat hang after it is killed- 
until the atmosphere has effected the same purpose, 
by a different process, and it be made tender by a 
decomposition, or partial putrefaction. But in the 
West- Indies it is common to see the animal alive 
in the market, and to have its joints smoking upon 
table the same day at dinner: it is slaughtered, 
dressed, and eaten, without the flesh growing cold ; 
and yet there is no complaint of the meat being 
hard or tough. 

These remarks will serve to lead your attention 
more particularly to the subject of climate, and to 
the effects of habit and original conformation; there- 
fore, without attempting to enter more particularly 
into all the various changes which the febrile action 
produces in destroying life, or the specific mode in 
which these changes are effected, I may proceed 
to state a few other general circumstances, which 
will show the application of what has been already 
said to the subject in question, viz. the continued 
or yellow fever. 

Creoles and negroes are not subject to the fever 
in its continued or most malignant form; but when 
it does invade them, it more commonly assumes a 
remittent or intermittent type. — In these classes, 
the original conformation, aided by a constant ex- 
posure to the heat and atmosphere of these regions, 

( 220 ) 

has established a due state of fibre, and given to the 
body a certain congeniality which empowers it to 
continue its healthy action, amidst all the circum- 
stances of climate and situation. 

Europeans who have resided during a period of 
several years in the West-Indies, are seldom at- 
tacked with the fever in its continued form ; but 
when it seizes them, it commonly assumes the type 
of a remittent.— In persons of this class, the body, 
from long exposure to the climate, has become 
creolise or acclimate, approaching to the conform 
mation of the natives, by having the original firm- 
ness of fibre reduced to the appropriate standard for 
continuing the healthy action, under exposure to 
preternatural heat. 

The strongest men — those of the most dense or 
rigid fibre, are most subject to the high degrees of 
the continued, or yelloru fever ; and are most fre- 
quently, and most rapidly destroyed by it. 

Women, children, convalescents from former 
malady, and those who have been reduced by the 
use of mercurial remedies, are less frequently the 
objects of its attack ; and when it does sieze them, 
it is commonly milder, and less rapid in its pro- 
gress. In these classes, the state of the animal fibre, 
either from original conformation, or from eventual 
( ircumstances, more nearly approaches to that of 
the Creoles and natives. 

In North-America, the inhabitants, who con- 
stantly reside in the most southern states, are seldom 

( 221 } 

attacked with the fever in its more violent, or con- 
tinued form ; while those of the north-east states are 
destroyed by it in great numbers : but, even in these 
states, it is remarked that the fever more readily 
seizes strangers from Europe, or peasants from the 
interior provinces, than the natives of the towns 
in which the disease prevails. — These facts are pe- 
culiarly striking, and they seem to admit of ready 
explanation. The inhabitants of the southern states, 
from residing in constant heat, are acclimates, and, 
in constitution, approach nearly to the Creoles or 
natives of the West-Indies: but those residing in 
the more northern states, although exposed to a 
very high degree of heat during the summer, can 
never become creolises, on account of the interven- 
ing winter, which annuallv renews the predisposi- 
tion, and creates a susceptibility of the disease — > 
still, from residing, during part of the year, in ex- 
cessive heat, and remaining, at all times, in the 
atmosphere of their towns, even the inhabitants of 
the place where the disease prevails, are, in some 
degree, less susceptible of the most malignant form 
of the fever than strangers from Europe, or pea- 
sants from the provinces, whose more dense and 
rigid fibre renders them in a peculiar manner pre- 

From these remarks, it would seem that the 

presence of contagion is in no gree necessary 

to the production of this fever. Indeed, its invasion 

<s governed by circumstances very opposite to sll 


( 222 ) 

the known laws of contagion : for, in proportion as 
the body approaches the Creole structure, so is it 
able to support the change of temperature, and to 
resist the fatal effects of the seasoning malady. If 
the constitution, either from natural organization, 
or from long residence, be assimilated to the cli- 
mate, i. e. if it be reduced to the common standard 
of the Creoles, it has nothing to apprehend from 
the disease ; but if it be not, the fever will, assur- 
edly, make its attack, without waiting for any such 
cause as contagion. 

Moreover, if it can be ascertained that certain 
classes of people are most liable to be attacked, and 
if it can be proved that there is a certain gradation, 
according as they have been more or less exposed 
to the influence of climate, it were equally unne- 
cessary and unphilosophical to call in the aid of a 
power, the application of whose laws it were im- 
possible to reconcile with the appearances observed^ 
No disease of known contagion is influenced by 
the circumstances which are daily seen to govern 
the progress of the yellow fever ; if, therefore, we 
are to regard contagion as the parent of this disease, 
it must be a contagion of a very uncommon and 
peculiar appetite; for it is a circumstance both sin- 
gular and unprecedented, that an active and wide- 
spreading contagion, prevailing in any particular 
country, should, expressly, avoid the inhabitants 
of that country, and only lie in wait for strangers ; 
and, further, that should these not chance to arrive, 

( 223 ) 

even for many years, this insatiate devourer, not 
relishing the food of her own country, should not 
once require sustenance, nor stir abroad for support, 
but content herself to fast, throughout the whole 
period, and again rush forth, with undiminished 
vigour, the very moment that strangers appear ! I 
think I might say, with the greatest correctness, 
that if no stranger, from a colder climate, should 
visit the West-India colonies for the space of five, 
ten, or any given number of years, that no instance 
of the yellow fever, distinct from the bilious remit- 
tent fever of the country, would be known during 
that period \ yet, if a body of men, unaccustomed 
to the climate, should arrive from Europe in the 
month of July or August immediately succeeding, a 
considerable proportion of them would be seized, 
and probably destroyed by this disease, before they 
had commemorated the first return of a new year: 
but can it be supposed that a most subtile and active 
contagion would thus remain latent, for any speci- 
fied term, amidst whole hosts of natives, suddenly, 
and as it were, impulsively, resume all its destruc- 
tive powers, as soon as a body of more robust fo- 
reigners should come within its reach ? 

In England, the harvest men and strangers who 
go into the fens of Kent or Lincolnshire in the 
autumn, are more readily attacked with the ende- 
mial fever of these provinces than the inhabitants 
who constantly reside in the atmosphere which 
causes it; yet we do not leam that, during the pre- 

( 224 J 

valence of any contagious malady in these districts, 
the contagion cautiously avoids the men of Kent: 
or Lincolnshire, to lie in wait for strangers ; nor 
perhaps, will any physician venture to assert that 
the Kentish fever is produced by contagion. 

It would seem more probable that the contagion 
of any particular country should regard the subjects 
of that country, in some degree, as her appropriate 
prey. The plica Polonica shuns not the peo le of 
Poland, nor the sibbins those of Scotland — neither 
have the yaws any disrelish for the Creoles or the 
Africans. But what seems most surprising is that 
this lady of choice appetite, who despises such 
common food as the languid blacks of the West- 
Indies, when she takes a sail down to America, as 
if her appetite were sharpened by the voyage, will,, 
occasionally, condescend to feast upon a fine stout 
negro of the United States. 

This is a fact, which is totally irreconcilable upon 
the principle of the disease proceeding from conta- 
gion.— -The negro of the West-Indies, from always 
living in a high degree of heat, has no susceptibility : 
but the negro of America acquires a predisposition 
from the recurrent cold of the winter. The fibre of 
the one is relaxed and yielding — of the other dense 
and resisting. — In the same way it is explained why 
the inhabitants of Louisiana, Georgia, and the 
Carolinas are less subject to the disease than those 
of Virginia, Pennsylvania, and New- York. Did 
the fever spread itself by contagion, we know of 

( 225 ) 

no cause why it should extend its ravages to the 
north instead of the south — why it should seize 
whites in preference to blacks — why prefer a robust 
European to a languid creole;— /ior why it should 
have a distaste for the sable race of the West-Indies 
— yet relish the negroes of North-America. 

It is not a law of contagion to make its attack 
upon the most robust and vigorous people: — more 
commonly it assails those of tender fibre. Were 
any given number of strong healthy men, and the 
same number of children to be exposed, at the 
same time, to the influence of the contagion of 
small-pox, measles, or scarlatina, common obser- 
vation informs us that the children would be found 
to be most susceptible of the impression, and at- 
tacked in the greatest number : but the very reverse 
of this would be the case were they to be exposed, 
in a similar manner, to the cause producing the 
yellow fever— the men would be found to be most 
susceptible, and a greater proportion of them would 
fall victims to the disease. 

Not only does this fever attack Europeans, newly 
arrived in the West-Indies, in preference to Creoles, 
negroes, and those who, by a long continued resi- 
dence, have become acclimates ; but even among 
these unhappy Europeans who chance to suit her 
appetite, she still has her partialities ; for the most 
healthy and robust, and in general those who are 
the earliest subjected to great exertions, and the 
high degrees of temperature, are sooner seized, 

( 226 ) 

and more rapidly destroyed, than those of laxer 
fibre, or those who have the opportunity of becom- 
ing more gradually acclimates. 

But the " New-comers," if exposed to the vaws, 
the cra-cra, or any other disease of decided conta- 
gion, are not found to be more susceptible than the 
Creoles or the negroes : although, with regard to 
the bites of musquitoes and other insects, the dif- 
ference of effect upon the Europeans and the peo- 
ple of the climate is as peculiarly marked as it is- 
with respect to the yellow fever. The small punc- 
ture made in the skin of a robust European by a mus- 
quito, or a sand-flv, frequently becomes inflamed,, 
tumefies, breaks into a sore, spreads into a malig- 
nant ulcer, and ultimately robs the hardy son of 
the North of his life — while the languid Creole, or 
the negro, quietly lets the insect bite, without ap- 
prehending anv of this sad train of consequences. 

Seeing that the fever can, unquestionably, be pro- 
duced without contagion, some contend that, in its 
passage through the body, it generates a matter 
which is capable of producing the disease by being 
diffused in the atmosphere^ and that it thus be- 
comes infectious. But even in thi3 widest sense of 
the term, I cannot consider it to be either a conta- 
gious or infectious malady ; for it does not appear 
that, by an inherent process, the living human 
body has the power of generating the appropriate 
pabulum necessary for the production or support 
cf this fever ; or that the disease, in. its progress- 

( 227 ) 

through the human frame, begets a poison siri ge- 
neris, which may be conveyed from one person to 
produce the disorder in another. 

The contagious or infectious fever which pro- 
ceeds from distempered human exhalations is a 
distinct malady. The yellow fever has a different 
origin — is different in its symptoms — and requires 
a different mode of treatment. They both have 
their different degrees, and the mild typhus, and 
typhus gravior of England are not more alike than 
the continued and the remittent fever of the West- 
Indies. Perhaps the mild and the confluent small- 
pox are more unlike: yet no one denies that either 
is small-pox — nor doubts that both are derived 
from the same cause — the same specific virus. 

If the medical attendants, and the (white) order- 
lies, who have been employed in the hospitals, have 
suffered from the fever ; still they have only suffered 
in common with the officers and soldiers, who have 
not been quartered near the hospitals ; and, as their 
proportion of duty and fatigue has been uncom- 
monly great, it were not to be expected that they 
could escape better than their comrades. 

But I have said that this fever does not attack 
the blacks of the West- Indies: I may, therefore, 
mention a remarkable fact, which, more than all 
others, would seem to militate against the doctrine 
of the yellow fever being, originally, a contagious, 
or becoming, in the course of its progress, an in- 
fectious malady, viz. that, of the multitudes of 

( 228 ) 

black men and women whom I have had occasion 
to see employed constantly in the hospitals, and 
who have executed all the menial duties about the 
sick, the dying, and the dead, I never yet knew 
even a single instance of any one of them, either 
male or female, taking the disease. Perhaps no one 
will contend that this would have happened had 
the hospitals been equally crowded with patients in 
small-pox, measles, scarlet fever, the common jail 
fever, or any complaint decidedly infectious.* 

The yellow fever prevails most commonly, and 
most extensively, at the decline of the wet season 
of the year, when the rains and the sun irregularly 
alternate, and cause unsettled weather; and this is 
also the period when the bilious remittent, and the 
ague appear among the Creoles and negroes. In 
the midst, or at the very height of the wet season, 
and during the finer dry season, the fever, in all its 

* In the year 1793, a body of emigrants from St. Domingo, 
amounting to upwards of 300 in number, who had made their 
escape from that colony, under all the circumstances of the 
mosi afflicting depression, arrived at Philadelphia, at the time 
when the yellow fever raged with its utmost malignity: yet, 
not one of them was attacked with the afflicting malady 
which was then desolating the town. And, as if expressly to 
make this fact the more striking, it likewise happened that the 
emigranjs who arrived at the same distressing period from 
Ireland, the States of Germany, and other parts of Europe, 
were attacked by the fever, even in greater proportion than 
the Americans themselves. — It is not the property of any con- 
tagion to exhibit such marked partialities The autumn tem- 
perature of Philadelphia was .congenial to the emigrants from 
St Domingo: the} were acclimates, and therefore not suscep- 
tible of the disease ; while those from Europe, being the in- 
habitants of colder regions, were in a peculiar degree predis- 

( 229 ) 

shapes, is far less common : likewise in the dry and 
elevated parts of the country, which are open to 
the breeze, it is out of all proportion less frequent 
than in low damp situations, in the vallies, and 
about the openings of the rivers. In North- Ame- 
rica it is principally, nay almost exclusively a dis- 
ease of the low and crowded towns, situated upon 
the borders of the rivers, and the bays of the sea ; 
and is scarcely known in the higher, or more inte- 
rior parts of the country. 

The great favouring circumstances, therefore, 
appear to be a high degree of temperature, and a 
moist state of the atmosphere ; to which may, per- 
haps, be added the ill chosen situation of the towns : 
but, from the particular season in which it spreads 
its ravages, and from all the host of concomitances, 
it would seem that we are to regard some miasma, 
or unwholesome exhalation, as the true pabulum of 
the disease. 

At the high period of the wet season the ditches 
and canals are full, and the brooks and rivulets 
fluent, so that the noxious exhalations are neither 
so readily formed, nor so easily taken up into the 
atmosphere : and, in the diy season, these deadly 
vapours are either chased away by the breeze, or 
rendered effete by the intense rays of the sun — but 
during the intermediate period, at the decline of 
the wet season, every circumstance tends to favour 
their production, and to promote their diffusion 
^nd suspension in die surrounding air. 

( 230 ') 

The fever is most readily generated in new colo- 
nies, where the land is only partially cleared of its 
wood, badly cultivated, and the half-drained soil 
left to exhale its noxious vapours into the surround- 
ing atmosphere. In the older colonies, M r here 
the forests have been long cut down, the land 
brought under general cultivation, and its surface 
more opened to the breeze, it is found to be less 
prevalent. Examples of this are seen in the old 
islands of Barbadoes and Antigua, contrasted with 
those of Grenada and Trinidad. The former are 
well cleared, and universally tilled, and from situ- 
ation, as well as culture, freely exposed to the in- 
fluence of the trade wind ; — in these, the disease 
but very seldom appears. The latter are not yet 
brought under general cultivation, but are partially 
covered with wood, and the atmosphere is damper, 
and less purified -by the breeze : — here, the fever 
frequently and fatally rages. 

In new settlements where the land is recently 
brought into cultivation, and not well cleared or 
drained, and particularly in the vicinity of the 
towns or habitations, which are commonly placed 
at die lowest and most insalubrious spots, for the 
convenience of commerce, the drainings of the 
higher lands, and often the filth of rivers, or of 
ha) s and inlets of the ocean, together with decayed 
leaves, plants, and roots, and, in short, the whole 
exiivice of the vegetable world collect, remain, and 
grow putrid, and, in such situations, the very 

( 231 ) 

weeds and coarser plants become rank and exu? 
berant, and, growing up only to decay, add to the 
fermenting mass, which, by holding the impure 
waters stagnant , accumulates and creates a noxious 
swamp ; and thus is generated the hideous Python 
who, though often conquered by the darting rays of 
Apollo, again uplifts his deadly front, and can only 
be subdued by the more steady and persevering in.. 
dustry of man. 

Wnen the effect of climate and situation shall be 
fully understood, and duly estimated, the yellow 
fever may be no longer the scourge of our mer- 
chants, or planters, and our armies : yet, after the 
long and fatal experience the world has had, it is 
equally lamentable and surprising that men should 
still blindly continue in error, with respect to the 
situations chosen for their towns and dwellings. 
Contrary to their better knowledge, they prefer 
the convenience of commerce to the more import- 
ant advantages of health, and fix their habitations, 
as it were expressly, upon the most unhealthy points 
of the globe. In every nation, and almost every 
colony, striking examples might be selected of the 
strange folly and neglect with which we regard a 
circumstance of such serious magnitude. Armies, 
perishing with fever, or dysentery, have been 
snatched from threatened destruction, by change 
of situation; and countries, almost meriting the 
reproachful term pestilential, have been rendered 
saiuonous by attentions to the soil ; still, on the 

( 232 ) 

score of health, much remains to be done, bv waa^ 
land fixing their residence where the atmosphere 
is least exposed to noxious exhalations. But, alas I 
commerce, and her prostitute suite, riches, dissi- 
pation, and luxury, deafen the loud calls of the 
fair Hygeia, with her more virtuous train, ease, 
tranquillity and happiness ; and while man remains 
ambitious, and wealth be made the public road to 
honours and distinctions in society, health will con- 
tinue to be only a secondary object of his consider- 
ation. It is in the province of the physician to ex- 
pose this fatal error — to philosophy it belongs to 
remove it. 

I would remark that the fever of these regions 
seems, in many respects, to be governed by the 
same circumstances as the endemic fever of Kent 
and Lincolnshire, in England, and, indeed, when it 
attacks the natives of the country, it even assumes 
the same type and symptoms : and I much suspect 
that if it could happen that the temperature of these 
provinces should continue as high as from 80° to 
90° during the summer, and heavy rains should 
fall in July, you would have yelloxv fever in the 
months of August and September : but, while the 
general heat of the summer shall continue below 
70°, there can be no fear of yellow fever being 
generated in England— <and still less of it being 
imported ; for this is just as improbable as that the 
Kentish fever should be carried off in a Scots trad- 
ing vessel, a»d spread among the inhabitants of 

( 233 ) 

Edinburgh, whose rocks, and streams, and healthy 
mountains preclude its visitation. 

In order to exhibit, in a more striking point of 
view, the similarity, or I might say the identity of 
the intermittent, the remittent, and the yellow fever 
of the West-Indies, and to show that they are only 
different degrees of the same disease, I may briefly 
enumerate the more prominent points in which the 
resemblance is observed. 

1. They run indiscriminately into each other — a 
quotidian, or a remittent, sometimes becoming a 
malignant yellow fever; and a yellow fever some- 
times degenerating into a remittent, or an inter- 

2. They are all seen to be connected with a de- 
rangement of the biliaiy system ; and a common se- 
quel of each, is a chronic affection of the liver. 

3. They all prevail, most extensively, at the same 
period of the year ; viz. the decline of the wet 


4. A bilious vomiting is common to them all. 

5. They are all, occasionally, attended with a yel- 
lowness of the skin and the eyes. 

6. In their relapses, and frequently in their first 
attack, they all bear a close alliance with the lunar 

7. The intermittent, the remittent, or the conti- 
nued type, or in other words, the milder, the inter- 
mediate, or the more m ilignant form is assumed, 
according to the state of vigour, the period of resi- 


( 234 ) 

ifcence in the climate, and other circumstances o£ 
the subject attacked. 

8. They all, occasionally, affect the same person 
various times. 

With respect to the alleged novelty, — the recent 
production or importation of the yellow fever, it 
appears to be an error, which may be explained 
away, by the circumstance mentioned above ; viz. 
that during a period of peace and tranquillity it is 
less frequent, and passes under the milder name 
of seasoning fever ; but from recurring in a time of 
war, it creates new alarm, and consequently issues 
forth with a new appellation. Its existence is, no 
doubt, coeval with the discovery of the colonies j 
for it is mentioned by some of the oldest authors 
who have written upon the subject of the West- 
Indies, and is pointedly noticed by Pere Labat, an 
author who himself experienced an attack of it in 
the year 1694. Were it fit to offer a conjecture 
with regard to its duration, I might suggest that, 
in all probability, it will continue to prevail so long 
as greedy lucre shall impel the inhabitants of cold 
climates to pay their devotions to Plutus, by a pil- 
grimage to tropical fields ; unless these fields shall 
be so improved by tillage as to destroy the ser- 
pent, and deprive the fever of the aliment neces* 
sary for its support. 




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Clare on Abscess, 

Clarke on Fever, 

Clarke's Compendium, 

Clarke on the Diseases of long 

Cleghome on the Diseases of 

Clossy's Observations, 

Compendium of Physic, 

Conversations on Chemistry, 

Cooper's Distiller, 

Couper on Impregnation, 

Cowper's Anatomy of the Mus» 

Cowper's Anatomy of the 

Cricliton on Mental Derange- 

r. \SfJ- SWORDS' s Medical Catalogue. 

®oxe on Vaccination, 

Cullen's Materia Medica, 

Cullen's Nosology, 

Cullen's Practice, 

Cullen's Physiology, 

Cullen's Synopsis, 

Currie on the Effects of Wa- 

Currie on the Kine Pock, 

Darwin's Botanic Garden, 

Barwin's Zoonomia, 

Darwin's Phytologia, being a 
Supplement to the Zoonomia, 

Davidson's Observations, 

Denman's Midwifery, 

Desault's Surgery, 

Dickson's Nomenclature, 

Dionis's Chirurgical Opera- 

Dobson on Airs, 

Douglass on Hydrocele, 

Drone's Surgery, 

Duncan's Annals of Medicine, 

Duncan's Medical Commenta- 

Earle on Hydrocele, 

Earle on the Cure of the Curv- 
ed Spine, 

Edinburgh Dispensatory, 

Edinburgh Ph)sical aud Lite- 
rary Essays, 6 vols. 

Edinburgh Practice, 

Elliot's Medical Philosophy, 

Elliot's Medical Pocket Book, 

Enchiridion Botanicuin, 

Essays, Physical, 2kc. 2 vols. 

Falconer's Synopsis, 

Ferguson's Electricity, 

Floyer on Bathing, 

Fontana on Poisons, 

Foot's Observations on Hunter, 

Fordyce's Practice, 

Fordyce's Dissertations on Fe- 

Fordyce's Elements, 

Fordyce on Food, 

Fothergill's Works, by Elliot, 

Fourcroy's Chemistry, 

Fox's Formula, 

Friend and Physician, 

Friend's History of Physic, 2 

Friend's Works, 

Fyfe's Anatomy, 2 vols. 

Gardiner on the Gout, 

Gibbon on Fevers, 

Gibson's Anatomy, 

Gilchrist on Sea Voyages, 

Gooch's Surgery, 

Goulard on Lead, 

Gregory's Economy of Nature, 

Gregory 's Conspectus, 

Gregory's Duties of a Physi- 

Gregory's Elements of the 
Practice of Physic, 

Gregory's Lectures, 

Gren's Chemistry, 

Haller's Cases, 

Haller's Pathology, 

Haller's Physiology, 

Hamilton's Cases, 

Hamilton's Midwifery, 

Hamilton's Regimental Sur- 

Hamilton on Hydrophobia, 

Hamilton on Scrophula, 

Hay's Surgery, 

Henry 'sEpitome of Chemistry > 

Herder's Philosophy, 

Higgins on Air, 

Hillary on Medical Knowledge, 

Hoffman's Practice, 

Home's Clinical Experiments, 

Home's Medical tacts, 

Home's Principia Medicine,. 

Home on Strictures, 

Home on Ulcers, 

Hooper's Anatomist's Vade 

Hooper's Medical Dictionary, 

Hopson on the D\sentery, 

Hosack's Introductory Lecture, 

Howard on the Venereal, 

7. & J. SWORBS'e Medical Catalogue. 

Jfloward on Lazarettocs, 

H-ward on Prisons, 

Hufdand on Health, 

Hull's defence of the Cesarean 

Hunter on Animal Economy, 

Hunter on the Venereal, 

Hunter on the Bbod, 

Hunter's Anatomy of the Gra- 
vid Uterus, 

Huxham's Works, 

Huxham on Fevers, 

Huxham on Deare, 

Ingram's Surgery, 

Innes on the Muscles, 

Jackson on Fever, 

Jackson on Sympathy, 

Jr.c vson's Cautions to Women, 

Jen ,er on Cow-Pock, 

Jemy's Lecuires, 3 vols. 

Johnson's Chemistrv, 

Jones's Medical Inquiry, 

Keil's Introduction, 

Keil's Animal Secretion, 

Kirwan on Manures, 

Kirwan on Phlog ston, 

Langrish's Practice, 

Lavoisier's Chemistry, 

Le Clerc's Surgery, 

Le Dran's Surgery, 

Lee's Botany, 

Le Grange's Chemistry, 

Lettsom's Memoirs, 

Lobb on painful Distempers, 

London Medical Review, 7 vs. 

London Prac'ice of Physic, 

London Pharmacopoeia, 

Macbride on Fixed Air, 

Maclean on CombusMon, 

Macquer's Chemistry, 

Maadsville on Hypochondria, 

Manning on Female Com- 

Manning's Improvements in 

Marrvai's Art of Healing, 

Martyn's Plates of Vegetables, 

Maton on Consumption's, 

Mead's Works, 

Mease on Hydrophobia, 

Medical Prescriptions, 

Medical and Physical Journal 1 , 

Medical Reposrory, 9 vols. 

Medical Transactions, 

Mekreen's Observations, 

Memoirs of the London Mfi« 
dical Society, 

Miller on Ashma, 

Mitch ill's Nomenclature, 

Monro on Huma.i Bones, &c, 

Monro on the Bursie Mucosae 
of the Human Body, 

Monro on the Brain, Lye, and* 

Monro on Miner?! Water, 

Monro's Surgery, 

Monro's Chemistry, 

Monro on Hospitals, 

Moore's Medical Sketches, 

M ■rgagni on Diseases, 3 vols. 

M->c.eley on Tropical Diseases, 

Moss on Children, 

Nayler on Ulcers, 

N sbet on Diet and Regimen, 

N'sbet's Clinical Guide, 5 volsv 

NsbeL's Ir.quiry, 

Nisbet on Venereal, 

Ontyd on D'seases, 

Osborn's Midwifery, 

Parkinson's Medical Admoni* 

Parkinson's Chemical Pocket- 

Parkinson's Hospital Pupil, 

Pearson's Nomenclature, 

Pearson on Lues, 

Percival's Essays, 2 vols. 

Physician's Vade Mecum, 

Picrc on Fire, 

Pole's Instructor, 

Priestley's Introduction to Elec- 

Priestley's System of Electri- 

T. &y. SWORDS'a Medical Catalogue. 

Priestley's Experiments and 
Observations on Air, 

Pringle on Diseases of the Ar- 

Porterheld on the Eye, 

Quincy's Lexicon improved, 

Ranby on Wounds, 

Reid on Consumptions, 

Reid's Essays, 

Richter on the Cataract, 

Robinson on Medicine, 

Robinson on Animal Economy, 

Rogers's Epidemical Diseases, 

Rollo on Diabetes, 

Rowley on Ulcers, 

Rowley on Female Complaints, 

Rush's Works, 5 vols. 

Rush's Introductory Lectures, 

Rush's Lectures on Animal 

Ruspini on Teeth, 

Russel on Necrosis, 

Russel on Morbid Affections, 

Saunders on the Liver, 

Saviard's Surgery, 

Schneiser's Mineralogy, 

Science of Life, 

Scomberg's Abridgment of 
Van Swieten, 4 vols. 

Seaman's Midwife's Monitor, 

Secrets of Modern Chemistry, 

Sharpe's Surgery, 

Sharpe's Inquiry, 

Sheldrake on the Club Foot, 

Shipmaster's Medical Assist- 

Simmons's Anatomy, 

Smellie's Midwifery, 

Smith's Revolutions of Che- 

Smith's Portable Library, 

Spallanzani's Dissertations, 

Spallanzani on the Blood, 

Start's Clinical and Anatomi- 
cal Observations, 

Struve on i he Physical Educa- 
tion of Children, by Willigh, 

Stork on Hemlock, 

Struve on Suspended A nitra- 
tion , 'i 

Swan's Sydenham, 

Swediaur on the Venereal, 

System of Anatomy, 3 vols. 

System of Anatomy from En- 

Temple's Practice, 

Thomson's Medical Consulta- 

Thompson's Family Physician, 

Thornton's Medical Extracts, 

Tissot on Health, 

Tissot on the Small-pox, 

Townsend's Philosophy of Mi- 

Townsend's Tracts and Obser- 
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Townsend's Physician's Vade 

Townsend's Elements of The- 

Transactions of the College of 
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Trotter on the Diseases of Sea- 

Trotter on Scurvy, 

Trye on the swelling of the 
lower Extremiies, 

Turner on Syphilis, 

Turner on the Skin, 

Turner's Ancient Physician's 

Turton's Medical Glossary, 

Turton's Translation of Lin- 

Underwood's Diseases of Chil. 

Underwood's Surgical Tracts, 

Van Swieren's Commentaries, 
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Walker on Nervous Diseases, 

Walker's Memoirs on Medi- 

Walhs on the Gout, 

5" . Uf y SWORDS'* Medical Catalogue. 

Wallis on Diseases, 

Walhs's Sydenham, 

Ware's Translation of Wen- 
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Ware on the Eye, 

Warner's Cases, 

Waters'* Abridgment of Bell's 

Watson's Chemical Essays, 5 

Webster's History of Pesti- 

Whately on Home's Strictures, 

White's Surgery, 

White's Cases, 

White on I.ymg-in Women, 

White's Aiialys.s, 

Whytt on Involuntary Mo- 

Wilkinson on the Spine, 

Wdlich on Diet and Regimen, 

Wilhch's Domestic Encycla* 
paid i a, 

Willan on Diseases of Lon« 

Wihner's Surgery, 

Wilson on Febrile Diseases, 

Wilson on Opium, 

Wmslow's Anatomy, 

Wintniignam on Animal 

Wiseman's Surgery, 

Withering on Scarlet Fevex 
and Sore-Throat, 

Withers on Asthma, 

Withers on Abuse of Medi- 

Withers on Weakness, 

Young's Physical Astronomy, 

Zimmerman's Practice, 

Zimmerman on Dysentery, &c. 

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